1497111843 NPI number — RESTORE & RELIEVE, PLLC

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 1497111843 NPI number — RESTORE & RELIEVE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTORE & RELIEVE, 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:
TEXAS RESTORE & RELIEVE, PA
Provider Other Organization Name Type Code:
4
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:
1497111843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6031 EAST MAIN STREET
Provider Second Line Business Mailing Address:
#318
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43213-3590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-859-2577
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 W 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-859-2577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
NESMITH
Authorized Official First Name:
DOROTHY
Authorized Official Middle Name:
SHELTON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
469-859-2577

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  L4597 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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