1801066014 NPI number — MARILYN RENEE SEYMOUR PA-C

Table of content: MARILYN RENEE SEYMOUR PA-C (NPI 1801066014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801066014 NPI number — MARILYN RENEE SEYMOUR PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEYMOUR
Provider First Name:
MARILYN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1801066014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16675 SOUTHWEST FWY STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-2580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-635-4530
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16675 SOUTHWEST FWY STE 105
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-635-4530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA05686 , 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: 199110101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8Y9075 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".