1477992717 NPI number — LOW-T PHYSICIANS SERVICES PLLC

Table of content: (NPI 1477992717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477992717 NPI number — LOW-T PHYSICIANS SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOW-T PHYSICIANS SERVICES PLLC
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:
LOW-T PHYSICANS PROFESSIONAL MBR
Provider Other Organization Name Type Code:
5
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:
1477992717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 306276
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37230-6276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-285-5664
Provider Business Mailing Address Fax Number:
405-285-6684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 E EDGEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIENDSWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77546-3818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-407-5698
Provider Business Practice Location Address Fax Number:
832-569-5311
Provider Enumeration Date:
06/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
REILLY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
877-544-5698

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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