1295068187 NPI number — MEDINA MEDICAL CENTER

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 1295068187 NPI number — MEDINA MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDINA MEDICAL CENTER
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:
1295068187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17510 W GRAND PKWY S
Provider Second Line Business Mailing Address:
STE 410
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-2645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-232-9772
Provider Business Mailing Address Fax Number:
281-232-3885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N TEEL DR
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
DEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78016-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-663-3500
Provider Business Practice Location Address Fax Number:
830-663-3505
Provider Enumeration Date:
09/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SIDHWA
Authorized Official First Name:
SHAHNAZ
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
281-232-9772

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  K1960 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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