1114969078 NPI number — INDEPENDENT CONCEPTS, INC.

Table of content: (NPI 1114969078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114969078 NPI number — INDEPENDENT CONCEPTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENT CONCEPTS, INC.
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:
1114969078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 5335
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-782-1372
Provider Business Mailing Address Fax Number:
956-782-1373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2003 N I RD
Provider Second Line Business Practice Location Address:
BAY # 7
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78589-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-782-1372
Provider Business Practice Location Address Fax Number:
956-782-1373
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
RENE
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
956-457-1485

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  10 , 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)