1376705947 NPI number — PICKARD GOSSETT SAWISKY LLP

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 1376705947 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:
6
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:
1376705947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 JIMMY JOHNSON BLVD
Provider Second Line Business Mailing Address:
STE 307
Provider Business Mailing Address City Name:
PORT ARTHUR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77640-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-722-0026
Provider Business Mailing Address Fax Number:
409-792-0201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 JIMMY JOHNSON BLVD
Provider Second Line Business Practice Location Address:
STE 307
Provider Business Practice Location Address City Name:
PORT ARTHUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77640-2000
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:
409-792-0201
Provider Enumeration Date:
06/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GOSSETT
Authorized Official First Name:
ODIS
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
409-722-0026

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  K2999 , 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)

  • Identifier: 0066JQ . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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