1235274200 NPI number — CYFAIR HEADACHE AND NEUROLOGICAL CLINIC

Table of content: (NPI 1235274200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235274200 NPI number — CYFAIR HEADACHE AND NEUROLOGICAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYFAIR HEADACHE AND NEUROLOGICAL CLINIC
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:
SALVADOR E. MURRA M.D.
Provider Other Organization Name Type Code:
5
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:
1235274200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11307 FM 1960 RD W STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77065-3687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-955-9155
Provider Business Mailing Address Fax Number:
281-955-9911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11307 FM 1960 RD W STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77065-3687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-955-9155
Provider Business Practice Location Address Fax Number:
281-955-9911
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MURRA
Authorized Official First Name:
SALVADOR
Authorized Official Middle Name:
Authorized Official Title or Position:
NEUROLOGIST
Authorized Official Telephone Number:
281-955-9155

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5301076 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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