1134341225 NPI number — ROBERT L QUILLIN, MD

Table of content: (NPI 1134341225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134341225 NPI number — ROBERT L QUILLIN, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT L QUILLIN, MD
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:
THE CHILDRENS CLINIC OF CLEAR LAKE
Provider Other Organization Name Type Code:
5
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:
1134341225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4346
Provider Second Line Business Mailing Address:
DEPT 494
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77210-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-338-5437
Provider Business Mailing Address Fax Number:
281-338-9543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 N TEXAS AVE
Provider Second Line Business Practice Location Address:
SUITE 4300
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77598-4966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-338-5437
Provider Business Practice Location Address Fax Number:
281-338-9543
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
QUILLIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
281-646-1935

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0017PC . This is a "BCBS GROUP ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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