1295887206 NPI number — PICKARD GOSSETT & SAWISKY LLP

Table of content: (NPI 1295887206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295887206 NPI number — PICKARD GOSSETT & SAWISKY LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PICKARD GOSSETT & SAWISKY LLP
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:
1295887206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1039 N TWIN CITY HWY STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEDERLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77627-3851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-722-0026
Provider Business Mailing Address Fax Number:
409-729-2783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1039 N TWIN CITY HWY STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEDERLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77627-3851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-722-0026
Provider Business Practice Location Address Fax Number:
409-729-2783
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAWISKY
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
409-722-0026

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1569600-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0066JQ . This is a "BLUE CROSS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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