1659374270 NPI number — ARLETTA A ROBERTS DBA HOLIDAES MEDICAL CONNECTION

Table of content: (NPI 1659374270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659374270 NPI number — ARLETTA A ROBERTS DBA HOLIDAES MEDICAL CONNECTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARLETTA A ROBERTS DBA HOLIDAES MEDICAL CONNECTION
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:
1659374270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1151 GLENDA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77581-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
281-485-0409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1151 GLENDA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77581-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-485-0409
Provider Business Practice Location Address Fax Number:
281-485-0409
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
LETA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-266-9962

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0066672 , 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: 157111901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 157111901,02,03 . This is a "CHC - DME SUPPLIER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 531627 . This is a "BCBS OF TX - DME SUPPLIER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 157111903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 157111902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 236953 . This is a "AMERIGROUP - DME SUPPLIER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 605791700 . This is a "OWCP- DME SUPPLIER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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