1699076794 NPI number — HOME VISITING DOCTORS MANAGEMENT LLC

Table of content: (NPI 1699076794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699076794 NPI number — HOME VISITING DOCTORS MANAGEMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME VISITING DOCTORS MANAGEMENT LLC
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:
1699076794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11200 BROADWAY ST STE 2743
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:
77584-9787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-398-6786
Provider Business Mailing Address Fax Number:
800-878-3830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5050 QUORUM DR STE 700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75254-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-445-2150
Provider Business Practice Location Address Fax Number:
800-463-3007
Provider Enumeration Date:
11/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ORO
Authorized Official First Name:
MARILOU
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC DIR
Authorized Official Telephone Number:
800-409-1920

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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