1487677829 NPI number — DEBORAH E THEIS PH.D.

Table of content: DEBORAH E THEIS PH.D. (NPI 1487677829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487677829 NPI number — DEBORAH E THEIS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THEIS
Provider First Name:
DEBORAH
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THEIS-HEDGE
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487677829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4314 YOAKUM BLVD
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:
77006-5818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-850-0049
Provider Business Mailing Address Fax Number:
713-627-7302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4314 YOAKUM BLVD
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:
77006-5818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-850-0049
Provider Business Practice Location Address Fax Number:
713-627-7302
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  25778 , 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: 102775710 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102775711 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102775712 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88186A . This is a "BCBS TX HOUSTON" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1025775701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102775702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102775704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102775705 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102775707 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102775709 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102775708 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00997619 . This is a "RR MCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01010614 . This is a "RR MCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 102775706 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88336A . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00961151 . This is a "RR MCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01011570 . This is a "RR MCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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