1720385115 NPI number — EXPERIENCE INFUSION CENTERS, LLC

Table of content: NICOLE MARIE ZIMMERMAN PHARMD (NPI 1013401330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720385115 NPI number — EXPERIENCE INFUSION CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXPERIENCE INFUSION CENTERS, 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:
1720385115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6300 RICHMOND AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77057-5931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-582-8919
Provider Business Mailing Address Fax Number:
832-582-8924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 RICHMOND AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77057-5931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-582-8919
Provider Business Practice Location Address Fax Number:
832-582-8924
Provider Enumeration Date:
02/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RUTHERFORD
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES/CEO
Authorized Official Telephone Number:
832-582-8919

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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