=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356746408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A AND H HOUSE CALLS AND MEDICAL MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2014
-----------------------------------------------------
Last Update Date | 10/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2185 BRINKER RD SUITE 100
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76208-6986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-487-8957
-----------------------------------------------------
Fax | 866-487-8505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2185 BRINKER RD SUITE 100
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76208-6986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-487-8957
-----------------------------------------------------
Fax | 866-487-8505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | JON HOPKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-364-3875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP126446TX
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | K6978
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------