1609814037 NPI number — LE SALVEO CARE CORP

Table of content: (NPI 1609814037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609814037 NPI number — LE SALVEO CARE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LE SALVEO CARE CORP
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:
SALVEO FAMILY CLINIC
Provider Other Organization Name Type Code:
3
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:
1609814037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
614 S. WATTERS RD.
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75013-4732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-509-3623
Provider Business Mailing Address Fax Number:
214-509-3620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
614 S. WATTERS RD.
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75013-4732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-509-3623
Provider Business Practice Location Address Fax Number:
214-509-3620
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
NGA
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
214-509-3623

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  L5017 , 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: 175303001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com