1457415572 NPI number — CARTER HEALTHCARE OF SOUTHEAST TEXAS, INC.

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 1457415572 NPI number — CARTER HEALTHCARE OF SOUTHEAST TEXAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARTER HEALTHCARE OF SOUTHEAST TEXAS, INC.
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:
1457415572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7725 W RENO AVE STE 332
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73127-9799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-947-7700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5265 LOUETTA RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77379-8136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-379-7052
Provider Business Practice Location Address Fax Number:
832-559-7059
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/ PRESIDENT
Authorized Official Telephone Number:
405-947-7700

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  010243 , 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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