1114076346 NPI number — KATHLEEN FIELDS

Table of content: KATHLEEN FIELDS (NPI 1114076346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114076346 NPI number — KATHLEEN FIELDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIELDS
Provider First Name:
KATHLEEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1114076346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1709 DRYDEN RD
Provider Second Line Business Mailing Address:
SUITE 1700
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-798-7356
Provider Business Mailing Address Fax Number:
713-798-6374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1709 DRYDEN RD
Provider Second Line Business Practice Location Address:
SUITE 1700
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-798-7356
Provider Business Practice Location Address Fax Number:
713-798-6374
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  22957 , 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: 88625C . This is a "TX-BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126126502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88625C . This is a "IN HARRIS - MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 430027394 . This is a "RAILROAD - MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com