1275725566 NPI number — BASILEIA GROUP INC

Table of content: (NPI 1275725566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275725566 NPI number — BASILEIA GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BASILEIA GROUP 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:
THE PHARMACY EXPERIENCE NETWORK
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:
1275725566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8118 FRY RD STE 1302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CYPRESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77433-7852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-263-7680
Provider Business Mailing Address Fax Number:
713-263-7685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8118 FRY RD STE 1302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77433-7852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-263-7680
Provider Business Practice Location Address Fax Number:
713-263-7685
Provider Enumeration Date:
08/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEATH
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER & CEO
Authorized Official Telephone Number:
713-263-7680

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  25684 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4545806 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 148375 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com