1083727986 NPI number — MR. MICHAEL SCOTT NELSON PA-C

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 1083727986 NPI number — MR. MICHAEL SCOTT NELSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
MICHAEL
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1083727986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 FM 1764 RD
Provider Second Line Business Mailing Address:
STE 190
Provider Business Mailing Address City Name:
LA MARQUE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77568-2826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-926-6229
Provider Business Mailing Address Fax Number:
713-926-9292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 TELEPHONE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77023-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-926-6229
Provider Business Practice Location Address Fax Number:
713-926-9292
Provider Enumeration Date:
08/16/2006

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: 363A00000X , with the licence number:  PA04398 , 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: 1083727986 . This is a "TRICARE SOUTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 187788801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187788802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8Y0711 . This is a "BCBSTX PROVIDER NO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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