1538494398 NPI number — BMO HEALTHCARE GROUP INC

Table of content: (NPI 1538494398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538494398 NPI number — BMO HEALTHCARE GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BMO HEALTHCARE GROUP 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:
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:
1538494398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13122 BROOKSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478-2787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-636-3165
Provider Business Mailing Address Fax Number:
281-857-6746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13122 BROOKSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478-2787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-636-3165
Provider Business Practice Location Address Fax Number:
281-857-6746
Provider Enumeration Date:
10/13/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EZENWA
Authorized Official First Name:
NKOLI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-564-5556

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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