1265598734 NPI number — ADOM REHAB AND PHYSICAL MEDICINE

Table of content: (NPI 1265598734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265598734 NPI number — ADOM REHAB AND PHYSICAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADOM REHAB AND PHYSICAL MEDICINE
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:
PAIN AIDE REHAB AND PHYSICAL MEDICINE
Provider Other Organization Name Type Code:
4
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:
1265598734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10600 FONDREN RD
Provider Second Line Business Mailing Address:
SUITE #101
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-776-0252
Provider Business Mailing Address Fax Number:
713-776-0093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10600 FONDREN RD
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-776-0091
Provider Business Practice Location Address Fax Number:
713-776-0093
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
TINA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
713-776-0252

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC6816 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0100X , with the licence number: F8454 , 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: P08815K05 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P0899443N7 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P089942N7 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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