1841668654 NPI number — IMPERIUM HEALTH RESOURCES, LLC

Table of content: (NPI 1841668654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841668654 NPI number — IMPERIUM HEALTH RESOURCES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMPERIUM HEALTH RESOURCES, 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:
1841668654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8821 DAVIS BLVD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
KELLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-593-6262
Provider Business Mailing Address Fax Number:
877-576-4230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8821 DAVIS BLVD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
KELLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-806-9544
Provider Business Practice Location Address Fax Number:
877-576-4230
Provider Enumeration Date:
09/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CRUMPLER
Authorized Official First Name:
STACY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
682-593-6262

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45D2094568 . This is a "CLIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com