1386872703 NPI number — PACIFIC DIAGNOSTICS, PA

Table of content: (NPI 1386872703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386872703 NPI number — PACIFIC DIAGNOSTICS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC DIAGNOSTICS, PA
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:
1386872703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 132618
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77393-2618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-292-1121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14450 TC JESTER
Provider Second Line Business Practice Location Address:
SUITE #250
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77014-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-774-7291
Provider Business Practice Location Address Fax Number:
713-774-5478
Provider Enumeration Date:
06/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIDDIQUI
Authorized Official First Name:
SAQIB
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-292-1121

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  L1710 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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