1083841464 NPI number — PALM ENDOSCOPY, PLLC

Table of content: (NPI 1083841464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083841464 NPI number — PALM ENDOSCOPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALM ENDOSCOPY, PLLC
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:
1083841464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 669
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77347-0669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-532-7311
Provider Business Mailing Address Fax Number:
713-532-7399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18929 HIGHWAY 59 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-4270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-446-4053
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AWASUM
Authorized Official First Name:
SERGIE-ALAIN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-576-8418

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  ASC163 , 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)