1063788735 NPI number — SHEVER FOOT SPECIALISTS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063788735 NPI number — SHEVER FOOT SPECIALISTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHEVER FOOT SPECIALISTS 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:
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:
1063788735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4582 KINGWOOD DR
Provider Second Line Business Mailing Address:
SUITE E#142
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77345-2640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-862-9503
Provider Business Mailing Address Fax Number:
281-862-9421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15055 EAST FWY
Provider Second Line Business Practice Location Address:
SUITE A20
Provider Business Practice Location Address City Name:
CHANNELVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77530-4144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-862-9503
Provider Business Practice Location Address Fax Number:
281-862-9241
Provider Enumeration Date:
03/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SHEVER
Authorized Official First Name:
SEPIDEH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-862-9503

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1743 , 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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