Provider Demographics
NPI:1063422194
Name:CZOP INC
Entity type:Organization
Organization Name:CZOP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CZOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-595-1811
Mailing Address - Street 1:844 S. FLEISHEL AVE.
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2042
Mailing Address - Country:US
Mailing Address - Phone:903-595-1811
Mailing Address - Fax:903-595-2809
Practice Address - Street 1:844 S. FLEISHEL AVE.
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2042
Practice Address - Country:US
Practice Address - Phone:903-595-1811
Practice Address - Fax:903-595-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50653237700000X
TX50636237700000X
TX50685237700000X
TX50630237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022136801Medicaid
TX0085MEOtherBCBS FACILITY NUMBER
TX516539OtherBCBS PROVIDER NUMBER
TXFTH007Medicare UPIN
TX0085MEOtherBCBS FACILITY NUMBER