1073920732 NPI number — MINIMAL ACCESS SPINE TECHNOLOGY

Table of content: MONICA THERESA TAYLOR MS, RDN, LDN (NPI 1538684840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073920732 NPI number — MINIMAL ACCESS SPINE TECHNOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINIMAL ACCESS SPINE TECHNOLOGY
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:
6
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:
1073920732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1651
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROSBY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77532-1651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-462-7684
Provider Business Mailing Address Fax Number:
888-832-5078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4582 KINGWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 187
Provider Business Practice Location Address City Name:
KINGWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77345-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-462-7684
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
VADHEIM
Authorized Official First Name:
COLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-231-7720

Provider Taxonomy Codes

  • Taxonomy code: 204R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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