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NPI 1104174259ActiveOrganization· Preferred Provider Organization· Richardson, TX

Preferred Provider Organization in Richardson, Texas, registered in NPPES in August 2012, part of Owner. The authorized official on file is Dedra Kay Maxey, Owner.

Overview

NPI1104174259
StatusActive
Entity typeOrganization (subpart)
Parent organizationOwner
NPI issuedAug 21, 2012
Last updated in NPPESJul 21, 2022

Specialties and licenses

TaxonomyCodeLicenseState
Preferred Provider Organization Primary305R00000X—TX

About license numbers in NPPES

Exclusion screening

ListResultDetails
HHS-OIG LEIE · Oct 9, 2026No matchChecked by NPI and by name + state
North Carolina Medicaid · Nov 10, 2026No match—
New York OMIG · Nov 10, 2026No match—
Ohio Medicaid · Nov 10, 2026No match—
Pennsylvania Medicheck · Nov 10, 2026No match—
Washington HCA · Nov 10, 2026No match—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)Not in the public enrollment file of Oct 1, 2026

Medicare sources and data years

Other Preferred Provider Organization providers in Richardson

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