Provider Demographics
NPI:1578780284
Name:EUGENE POSNOCK M D P A
Entity Type:Organization
Organization Name:EUGENE POSNOCK M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:POSNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-571-6622
Mailing Address - Street 1:2305 CENTRAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6111
Mailing Address - Country:US
Mailing Address - Phone:817-571-6622
Mailing Address - Fax:817-868-1962
Practice Address - Street 1:2305 CENTRAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6111
Practice Address - Country:US
Practice Address - Phone:817-571-6622
Practice Address - Fax:817-868-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9644207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0354102-01Medicaid
TXD18876Medicare UPIN
TX00QB40Medicare PIN