1861527061 NPI number — ROCKMAN WOMENS WELLNESS

Table of content: (NPI 1861527061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861527061 NPI number — ROCKMAN WOMENS WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKMAN WOMENS WELLNESS
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:
6
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:
1861527061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23920 KATY FWY
Provider Second Line Business Mailing Address:
SUITE 540
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-1341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-464-8540
Provider Business Mailing Address Fax Number:
281-392-2044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23920 KATY FREEWAY
Provider Second Line Business Practice Location Address:
SUITE 540
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77494-5603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-464-8540
Provider Business Practice Location Address Fax Number:
281-392-2044
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROCKMAN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
IAN
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
713-464-8540

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G6383 , 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: 1785883-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0029NE . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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