1710300371 NPI number — SORS MEDICAL GROUP, INC

Table of content: (NPI 1710300371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710300371 NPI number — SORS MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SORS MEDICAL 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:
1710300371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7111 HARWIN DR
Provider Second Line Business Mailing Address:
SUITE # 125B
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77036-2129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-623-7347
Provider Business Mailing Address Fax Number:
832-649-4401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7111 HARWIN DR
Provider Second Line Business Practice Location Address:
SUITE # 125B
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-623-7347
Provider Business Practice Location Address Fax Number:
832-649-4401
Provider Enumeration Date:
01/31/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TURLEY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
832-623-7347

Provider Taxonomy Codes

  • Taxonomy code: 2081N0008X , with the licence number:  8211 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8211 . This is a "CERTIFICATE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".