Basic Information
| Provider Information | |||||||||
| NPI: | 1962799163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADGER | ||||||||
| FirstName: | BAY | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | P.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8404 WARREN PKWY | ||||||||
| Address2: | APT 333 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750347075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187739266 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4600 FULLER DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750386551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694209500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2011 | ||||||||
| LastUpdateDate: | 07/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 2052850 | 01 | TX | LICENSE | OTHER |