1831485119 NPI number — NEW CANEY URGENT CARE CENTER, PA

Table of content: (NPI 1831485119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831485119 NPI number — NEW CANEY URGENT CARE CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW CANEY URGENT CARE CENTER, PA
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:
1831485119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CANEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77357-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-569-0045
Provider Business Mailing Address Fax Number:
281-399-5677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20185 US HIGHWAY 59
Provider Second Line Business Practice Location Address:
SUITE 76
Provider Business Practice Location Address City Name:
NEW CANEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77357-8358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-569-0045
Provider Business Practice Location Address Fax Number:
281-399-5677
Provider Enumeration Date:
06/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WILLENS
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
713-569-0045

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  G9676 , 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)





Copyright © 2007-2024 www.npivalidator.com