1043305162 NPI number — SYNERGY REHAB CENTER LP

Table of content: (NPI 1043305162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043305162 NPI number — SYNERGY REHAB CENTER LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYNERGY REHAB CENTER LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043305162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
561 MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
SUITE - B
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77598-4240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-554-9885
Provider Business Mailing Address Fax Number:
281-554-9887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
561 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE - B
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77598-4240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-554-9885
Provider Business Practice Location Address Fax Number:
281-554-9887
Provider Enumeration Date:
10/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAJAMANI
Authorized Official First Name:
GANESH
Authorized Official Middle Name:
N
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
281-554-9885

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  1083491 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8T1764 . This is a "BCBS HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: PT1083491 . This is a "HUMANA HMO/PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2165209 . This is a "FIRST HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000017KS00 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3291703, 7851518 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".