Basic Information
| Provider Information | |||||||||
| NPI: | 1578643417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORRIE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 3201 TEASLEY LN | ||||||||
| Address2: | STE 102 | ||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762108302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405651510 | ||||||||
| FaxNumber: | 9402430607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 05/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | J5653 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 137345802 | 05 | TX | MEDICAID | 140620100 | 01 | TX | FIRSTCARE PIN | OTHER | 5076004 | 01 | TX | AETNA PIN | OTHER | 854435 | 01 | TX | FIRSTHEALTH PIN | OTHER | 124921103 | 05 | TX | MEDICAID | TORSF86781 | 01 | TX | CCHIP PIN | OTHER | 1284012 | 01 | TX | UHC PIN | OTHER | 3444098 | 01 | TX | CIGNA PIN | OTHER | 1750369203 | 01 | GRP NPI NUMBER | OTHER | 86462G | 01 | TX | BCBSTX IND PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER |