1477839603 NPI number — WOODLANDS PAIN IP CENTERS MD PA

Table of content: TIMOTHY FOLMAR LPC, NCC (NPI 1750017059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477839603 NPI number — WOODLANDS PAIN IP CENTERS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODLANDS PAIN IP CENTERS MD PA
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:
1477839603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5318 WESLAYAN ST STE 183
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77005-1048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-462-9142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 FM 1960 RD W
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:
77068-3727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-462-9142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NEWBURY
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIVISION MANAGER
Authorized Official Telephone Number:
281-462-1285

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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