1619908415 NPI number — QAVU, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619908415 NPI number — QAVU, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QAVU, LLC
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:
1619908415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3945
Provider Second Line Business Mailing Address:
DEPT 235
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77253-3945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-358-8114
Provider Business Mailing Address Fax Number:
281-358-0609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10918 EAST FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77029-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-451-4299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VU
Authorized Official First Name:
QUAN
Authorized Official Middle Name:
ANH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-250-6298

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  J6792 , 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: 0052TJ . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 212888601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 215788501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DQ6815 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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