1699957092 NPI number — MAJESTIC SPRINGS, LLC

Table of content: (NPI 1699957092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699957092 NPI number — MAJESTIC SPRINGS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAJESTIC SPRINGS, 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:
MAJESTIC SPRINGS WELLNESS CENTER
Provider Other Organization Name Type Code:
5
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:
1699957092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4660 SWEETWATER BLVD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-3166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-980-6799
Provider Business Mailing Address Fax Number:
281-980-8157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4660 SWEETWATER BLVD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-3166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-980-6799
Provider Business Practice Location Address Fax Number:
281-980-8157
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAMIREZ
Authorized Official First Name:
GLENDA
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
V.P. OF OPERATIONS
Authorized Official Telephone Number:
281-980-6799

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  J2159 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: J2159 , 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: 8U7708 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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