1104128271 NPI number — HARVEY L KLEIN MD PA

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 1104128271 NPI number — HARVEY L KLEIN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARVEY L KLEIN MD PA
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:
1104128271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6560 FANNIN ST
Provider Second Line Business Mailing Address:
STE 1234
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-795-4774
Provider Business Mailing Address Fax Number:
713-795-4865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6560 FANNIN ST
Provider Second Line Business Practice Location Address:
STE 1234
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-795-4774
Provider Business Practice Location Address Fax Number:
713-795-4865
Provider Enumeration Date:
11/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
HARVEY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-795-4774

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  D5065 , 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: 280431201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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