1811325954 NPI number — COMPREHENSIVE INJURY TREATMENT SERVICES PLLC

Table of content: (NPI 1811325954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811325954 NPI number — COMPREHENSIVE INJURY TREATMENT SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE INJURY TREATMENT SERVICES PLLC
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:
ANTHONY MEDICAL AND WELLNESS CENTER
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:
1811325954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1602 W AVENUE A
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
TEMPLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76504-4080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-778-6474
Provider Business Mailing Address Fax Number:
254-778-6491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1602 W AVENUE A
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76504-4080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-778-6474
Provider Business Practice Location Address Fax Number:
254-778-6491
Provider Enumeration Date:
10/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ALI
Authorized Official First Name:
HAMEED
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
254-899-2225

Provider Taxonomy Codes

  • Taxonomy code: 2083P0500X , with the licence number:  P1691 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: P1691 , 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)





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