1831824754 NPI number — CENTURION PLACE

Table of content: JESSICA ZHOU DURK MD (NPI 1891938742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831824754 NPI number — CENTURION PLACE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTURION PLACE
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:
1831824754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77001-0105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-939-1966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 WILCREST DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77042-2754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-364-2828
Provider Business Practice Location Address Fax Number:
713-358-9692
Provider Enumeration Date:
07/24/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NAVARRE
Authorized Official First Name:
FREDRIC
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
225-939-1966

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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