1063590248 NPI number — MR. RUPERT E JOHNSON R.N. B.ED

Table of content: MR. RUPERT E JOHNSON R.N. B.ED (NPI 1063590248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063590248 NPI number — MR. RUPERT E JOHNSON R.N. B.ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
RUPERT
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.N. B.ED
Provider Gender Code:
M

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:
1063590248
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10101 SOUTHWEST FWY
Provider Second Line Business Mailing Address:
STE. 400
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77074-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-207-5338
Provider Business Mailing Address Fax Number:
281-207-5339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 SUGAR GROVE BLVD
Provider Second Line Business Practice Location Address:
STE. 290
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77477-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-207-5338
Provider Business Practice Location Address Fax Number:
281-207-5339
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  0074527 , 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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