1063526051 NPI number — HARRIS CTY SHERIFFS DEPT CLINIC PHCY

Table of content: (NPI 1063526051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063526051 NPI number — HARRIS CTY SHERIFFS DEPT CLINIC PHCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRIS CTY SHERIFFS DEPT CLINIC PHCY
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:
HARRIS CITY SHERIFFS DEPARTMENT CLINIC PHARMACY
Provider Other Organization Name Type Code:
3
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:
1063526051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 BAKER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77002-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-755-6722
Provider Business Mailing Address Fax Number:
713-755-1246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 BAKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-755-6722
Provider Business Practice Location Address Fax Number:
713-755-1246
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
SUN CHAING
Authorized Official Middle Name:
Authorized Official Title or Position:
PHCY DIRECTOR
Authorized Official Telephone Number:
713-755-6722

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  08072 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2099200 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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