Provider Demographics
NPI:1760782577
Name:A. T. PLATINUM SERVICES
Entity Type:Organization
Organization Name:A. T. PLATINUM SERVICES
Other - Org Name:A. T. PLATINUM SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNRE
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:DEIONE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-922-1004
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:DALE
Mailing Address - State:TX
Mailing Address - Zip Code:78616-0087
Mailing Address - Country:US
Mailing Address - Phone:512-922-1004
Mailing Address - Fax:512-291-7154
Practice Address - Street 1:355 HAZELNUT CV
Practice Address - Street 2:
Practice Address - City:DALE
Practice Address - State:TX
Practice Address - Zip Code:78616-4136
Practice Address - Country:US
Practice Address - Phone:512-922-1004
Practice Address - Fax:512-291-7154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A. T. PLATINUM SREVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health