1083878391 NPI number — DEVIATIONS, INC.

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 1083878391 NPI number — DEVIATIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVIATIONS, INC.
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:
1083878391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26203 OAKRIDGE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-882-4268
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 RANCH CREEK WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAGNOLIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-882-4268
Provider Business Practice Location Address Fax Number:
281-292-2365
Provider Enumeration Date:
07/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NICHOLASAS
Authorized Official First Name:
JANET
Authorized Official Middle Name:
CLAIRE
Authorized Official Title or Position:
PRESIDENT/SECRETARY/TREASURER
Authorized Official Telephone Number:
713-882-4268

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  15464 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 1480 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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