1134747678 NPI number — LOW FIFTY CONSTRUCTION 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 1134747678 NPI number — LOW FIFTY CONSTRUCTION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOW FIFTY CONSTRUCTION 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:
1134747678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3606 GRASSMERE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78415-3607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-510-9372
Provider Business Mailing Address Fax Number:
361-334-6273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6201 JESSICA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78414-3667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-765-5212
Provider Business Practice Location Address Fax Number:
361-334-6273
Provider Enumeration Date:
07/10/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAMEZ
Authorized Official First Name:
NORMA
Authorized Official Middle Name:
DAISY
Authorized Official Title or Position:
CLAIMS ADMINISTRATOR
Authorized Official Telephone Number:
361-510-9372

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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