1053318840 NPI number — ADVANCED FUNCTIONAL ASSESSMENTS INC

Table of content: (NPI 1053318840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053318840 NPI number — ADVANCED FUNCTIONAL ASSESSMENTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED FUNCTIONAL ASSESSMENTS 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:
C FOSTER AND ASSOCIATES
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:
1053318840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 BAYSHORE BLVD
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77504-1952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-943-1100
Provider Business Mailing Address Fax Number:
713-943-1178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 BAYSHORE BLVD
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504-1952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-943-1100
Provider Business Practice Location Address Fax Number:
713-943-1178
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
CLINTON
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER PHYSICAL THERAPIST DIRECTOR
Authorized Official Telephone Number:
713-943-1100

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , 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: 7683311 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0019HC . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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