1780814822 NPI number — EVANGEL PHC SERVICES INC.

Table of content: (NPI 1780814822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780814822 NPI number — EVANGEL PHC SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVANGEL PHC SERVICES 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:
EVANGEL PROVIDER ASSISTANCE SERVICES
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:
1780814822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35447
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:
77235-5447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-923-6620
Provider Business Mailing Address Fax Number:
713-921-0008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6464 SAVOY DR STE 825
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:
77036-3395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-923-6620
Provider Business Practice Location Address Fax Number:
713-921-0008
Provider Enumeration Date:
07/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
IROH
Authorized Official First Name:
MERCY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-923-6620

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 015336 , 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: 015336 . This is a "DADS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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