Provider Demographics
NPI:1265441513
Name:EVELYN ARCHER MDPA
Entity Type:Organization
Organization Name:EVELYN ARCHER MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-358-8392
Mailing Address - Street 1:PO BOX 8337
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79114-8337
Mailing Address - Country:US
Mailing Address - Phone:806-355-6593
Mailing Address - Fax:806-352-8774
Practice Address - Street 1:1900 S COULTER ST
Practice Address - Street 2:UNIT B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1784
Practice Address - Country:US
Practice Address - Phone:806-358-8395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0139207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
070016266OtherRAILROAD MEDICARE
TX098853701Medicaid
126925100OtherFIRSTCARE
TX098853701Medicaid
070016266OtherRAILROAD MEDICARE