1881945871 NPI number — JD UNITED, PA

Table of content: (NPI 1881945871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881945871 NPI number — JD UNITED, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JD UNITED, PA
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:
1881945871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3917 PEBBLE BROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEAGUE CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77573-3766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-524-5355
Provider Business Mailing Address Fax Number:
832-218-0917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 BINZ ST
Provider Second Line Business Practice Location Address:
SUITE 460
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77004-6900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-621-2600
Provider Business Practice Location Address Fax Number:
832-218-0917
Provider Enumeration Date:
10/01/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FUKE
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-991-2200

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  M6138 , 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)