1073726667 NPI number — CHANNELVIEW VOLUNTEER FIRE D

Table of content: (NPI 1073726667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073726667 NPI number — CHANNELVIEW VOLUNTEER FIRE D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANNELVIEW VOLUNTEER FIRE D
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:
CHANNELVIEW VOLUNTEER FIRE DEPARTMENT
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:
1073726667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 691363
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77269-1363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-397-0397
Provider Business Mailing Address Fax Number:
281-397-6934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16010 RIDLON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANNELVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77530-3614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-452-5782
Provider Business Practice Location Address Fax Number:
281-452-2100
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAAKE
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
AUTHORIZED AGENT
Authorized Official Telephone Number:
281-397-0397

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  101014 , 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: 000258601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 509427 . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1635642 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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