Provider Demographics
NPI:1801899380
Name:MONICA OLIVIER DO PA
Entity type:Organization
Organization Name:MONICA OLIVIER DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-222-4800
Mailing Address - Street 1:560 WEST MAIN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3604
Mailing Address - Country:US
Mailing Address - Phone:214-222-4800
Mailing Address - Fax:214-222-4882
Practice Address - Street 1:560 WEST MAIN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3604
Practice Address - Country:US
Practice Address - Phone:214-222-4800
Practice Address - Fax:214-222-4882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONICA OLIVIER DO PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-27
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146283001Medicaid
TX146283001Medicaid