1578729646 NPI number — CORPORATE MEDICAL CLINIC,LP

Table of content: (NPI 1578729646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578729646 NPI number — CORPORATE MEDICAL CLINIC,LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORPORATE MEDICAL CLINIC,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:
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:
1578729646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1229 CORPORATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSENBERG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77471-2135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-342-3400
Provider Business Mailing Address Fax Number:
281-342-3404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1229 CORPORATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSENBERG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77471-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-342-3400
Provider Business Practice Location Address Fax Number:
281-342-3404
Provider Enumeration Date:
07/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FERGUSON
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
832-244-8865

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0A3548 . This is a "CORPORATE MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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