1942511878 NPI number — ELITE ORTHOPEDICS SPORTS MEDICINE

Table of content: JAMIE LEE HUNTER QMHP (NPI 1437405271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942511878 NPI number — ELITE ORTHOPEDICS SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE ORTHOPEDICS SPORTS MEDICINE
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:
1942511878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8603 BROADWAY ST
Provider Second Line Business Mailing Address:
SUITE #101
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584-8171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-997-3717
Provider Business Mailing Address Fax Number:
281-997-3817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8603 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584-8171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-997-3717
Provider Business Practice Location Address Fax Number:
281-997-3817
Provider Enumeration Date:
06/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BARRE
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
TORRES
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
281-997-3717

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  981 , 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)





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