1962402420 NPI number — DIGESTIVE SPECIALISTS OF NORTH HARRIS COUNTY PA

Table of content: (NPI 1962402420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962402420 NPI number — DIGESTIVE SPECIALISTS OF NORTH HARRIS COUNTY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE SPECIALISTS OF NORTH HARRIS COUNTY 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:
DIGESTIVE SPECIALISTS, PA
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:
1962402420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130894
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77393-0894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-321-0033
Provider Business Mailing Address Fax Number:
936-321-0032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 VISION PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77384-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-321-0033
Provider Business Practice Location Address Fax Number:
936-321-0032
Provider Enumeration Date:
07/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILCOX
Authorized Official First Name:
LIZ
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
936-321-0033

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , 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: 0057EB . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CI6786 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 158215701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158069801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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