1013952613 NPI number — TCG INTERESTS, LLC

Table of content: (NPI 1013952613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013952613 NPI number — TCG INTERESTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TCG INTERESTS, LLC
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:
TCG INTERESTS, LTD
Provider Other Organization Name Type Code:
4
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:
1013952613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9349 KIRBY DR
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:
77054-2516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-383-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9349 KIRBY DR
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:
77054-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-383-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZEHNDER
Authorized Official First Name:
CAMEO
Authorized Official Middle Name:
KAE
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
651-642-1825

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1560161-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1560161-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".