1346517299 NPI number — AMEDCO TEXAS LLC

Table of content: (NPI 1346517299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346517299 NPI number — AMEDCO TEXAS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMEDCO TEXAS LLC
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:
INTERNATIONAL EYE LASER CENTER
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:
1346517299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8076 W SAHARA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-7930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-881-0022
Provider Business Mailing Address Fax Number:
702-255-0022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
926 N WILCREST DR
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:
77079-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-984-9777
Provider Business Practice Location Address Fax Number:
713-463-7703
Provider Enumeration Date:
11/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMACK
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
877-881-0022

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , 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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