1073507141 NPI number — KOTZUR HUBER LLP

Table of content: (NPI 1073507141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073507141 NPI number — KOTZUR HUBER LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOTZUR HUBER LLP
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:
MID COUNTY FAMILY CLINIC
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:
1073507141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1409 S HIGHWAY 69
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEDERLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77627-7842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-727-4422
Provider Business Mailing Address Fax Number:
409-729-5662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1409 S HIGHWAY 69
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEDERLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77627-7842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-727-4422
Provider Business Practice Location Address Fax Number:
409-729-5662
Provider Enumeration Date:
09/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KOTZUR
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SENIOR PARTNER
Authorized Official Telephone Number:
409-727-4422

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 157788401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0010JY . This is a "GROUP BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DA1083 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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