1023363595 NPI number — VINCENT FAMILY ENTERPRISES, INC.

Table of content: MEREDITH HOLLY RANDLE MDIV, LPC (NPI 1275054413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023363595 NPI number — VINCENT FAMILY ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VINCENT FAMILY ENTERPRISES, 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:
Provider Other Organization Name Type Code:
6
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:
1023363595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8910 SW 34TH AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79124-2065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8910 SW 34TH AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79124-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-356-1362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VINCENT
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
806-335-0431

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  11132 , 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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