1467403477 NPI number — COLLEGE STATION HOSPITAL LP

Table of content: AMBER LUCILLE GRABER NP-C (NPI 1649649781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467403477 NPI number — COLLEGE STATION HOSPITAL LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLEGE STATION HOSPITAL LP
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:
COLLEGE STATION MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1467403477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848526
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-8526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-764-5100
Provider Business Mailing Address Fax Number:
979-696-7373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1604 ROCK PRAIRIE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE STATION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77845-8345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-764-5100
Provider Business Practice Location Address Fax Number:
979-696-7373
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LALOR
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR/DELEGATED OFFICIAL
Authorized Official Telephone Number:
615-925-4565

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 000071 , 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: 022501301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020860501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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