1275928236 NPI number — BRAEGEN ENTERPRISES Ammie J Jaggars Licensed Surgical First Assist

Table of content: Ammie J Jaggars Licensed Surgical First Assist (NPI 1275928236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275928236 NPI number — BRAEGEN ENTERPRISES Ammie J Jaggars Licensed Surgical First Assist

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAEGEN ENTERPRISES
Provider Last Name:
Jaggars
Provider First Name:
Ammie
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Licensed Surgical First Assist
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:
1275928236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9451 E. Winding Hill Ave
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
Lone Tree
Provider Business Mailing Address State Name:
Co
Provider Business Mailing Address Postal Code:
80124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 F.M 1960 Rd.
Provider Second Line Business Practice Location Address:
Suite 560
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-223-2033
Provider Business Practice Location Address Fax Number:
832-582-3665
Provider Enumeration Date:
04/06/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JAGGARS
Authorized Official First Name:
AMMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-463-6309

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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