1508911629 NPI number — NORTHEAST NSG. SVCS. PHC HMO INC

Table of content: (NPI 1508911629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508911629 NPI number — NORTHEAST NSG. SVCS. PHC HMO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST NSG. SVCS. PHC HMO INC
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:
NORTHEAST NSG.SVCS. PHC HMO INC
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:
1508911629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77222-6236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-694-2742
Provider Business Mailing Address Fax Number:
713-862-4010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6643 W MONTGOMERY RD
Provider Second Line Business Practice Location Address:
NA
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77091-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-964-2742
Provider Business Practice Location Address Fax Number:
713-862-4010
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARNER
Authorized Official First Name:
VIVIAN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
713-694-2742

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  007149 , 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)





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