1124289061 NPI number — BIOFLEX MEDICAL TECHNOLOGIES

Table of content: (NPI 1124289061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124289061 NPI number — BIOFLEX MEDICAL TECHNOLOGIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOFLEX MEDICAL TECHNOLOGIES
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:
MATTHEW W WILLIAMSON
Provider Other Organization Name Type Code:
3
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:
1124289061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 TODVILLE RD APT 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEABROOK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77586-3915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-286-5272
Provider Business Mailing Address Fax Number:
214-941-2735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
628 TENNA LOMA CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75208-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-646-4848
Provider Business Practice Location Address Fax Number:
214-941-2735
Provider Enumeration Date:
06/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMSON
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
469-286-5272

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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