1962548602 NPI number — INTEGRITY MEDICAL SUPPLY ETC

Table of content: (NPI 1962548602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962548602 NPI number — INTEGRITY MEDICAL SUPPLY ETC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRITY MEDICAL SUPPLY ETC
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:
INNER DOOR COUNSELING & REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
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:
1962548602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 741226
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:
77274-1226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-563-5889
Provider Business Mailing Address Fax Number:
281-575-0153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 HILLCROFT ST
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77081-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-278-8870
Provider Business Practice Location Address Fax Number:
713-278-9711
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ETUKUDO
Authorized Official First Name:
ASSUMPTA
Authorized Official Middle Name:
SUNDAY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
713-278-8870

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  3504-3505 , 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: 175737901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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