Active NPI
Charles T Maxvill Jr., DO
- Geriatric Medicine (Internal Medicine) Physician
- Euless, TX
National Provider Identifier
1730103664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- F5299
- Practice address
- 251 Westpark Way Ste 210
Euless, TX 76040-3742 - Phone
- (682) 236-3656
- Fax
- (855) 813-9308
- NPI assigned
- Jul 26, 2006
- Last updated
- Sep 2, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | F5299 | TX | Primary |
Addresses
Primary practice location
251 Westpark Way Ste 210
Euless, TX 76040-3742
Mailing address
251 Westpark Way Ste 210
Euless, TX 76040-3742
Phone (682) 236-3656
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 131808114 | Medicaid | TX | |
| 131808108 | Medicaid | TX | |
| 1318080107 | Medicaid | TX | |
| 131808109 | Medicaid | TX | |
| 131808110 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F5299 | TX | MD | Geriatric Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409616000000",
"number": "1730103664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "251 WESTPARK WAY STE 210",
"city": "EULESS",
"state": "TX",
"postal_code": "760403742",
"telephone_number": "682-236-3656",
"fax_number": "855-813-9308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "251 WESTPARK WAY STE 210",
"city": "EULESS",
"state": "TX",
"postal_code": "760403742",
"telephone_number": "682-236-3656",
"fax_number": "855-813-9308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAXVILL",
"first_name": "CHARLES",
"middle_name": "T",
"name_suffix": "Jr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2014-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "TX",
"license": "F5299",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "131808114",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "131808108",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1318080107",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "131808109",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "131808110",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Euless, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.