1407855893 NPI number — BELLAIRE FAMILY AND GENERAL PRACTICE ASSOCIATES, P.A.

Table of content: (NPI 1407855893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407855893 NPI number — BELLAIRE FAMILY AND GENERAL PRACTICE ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLAIRE FAMILY AND GENERAL PRACTICE ASSOCIATES, P.A.
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:
1407855893
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:
5420 DASHWOOD DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77081-5357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-664-0719
Provider Business Mailing Address Fax Number:
713-664-1272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5420 DASHWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77081-5357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-664-0719
Provider Business Practice Location Address Fax Number:
713-664-1272
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GARB
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
JULIAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-664-0719

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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: LK08 . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153313501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130087 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: J7064 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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