1740754944 NPI number — GASTRO1 RECEIVABLES PURCHASING, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740754944 NPI number — GASTRO1 RECEIVABLES PURCHASING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTRO1 RECEIVABLES PURCHASING, 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:
1740754944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4450 E SAM HOUSTON PKWY S STE H2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77505-3950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-910-7779
Provider Business Mailing Address Fax Number:
713-910-7760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3534 VISTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-947-0330
Provider Business Practice Location Address Fax Number:
713-947-6562
Provider Enumeration Date:
01/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DACCAK
Authorized Official First Name:
RUKAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
713-910-7779

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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