1972050250 NPI number — FIGMENT ENTERPRISES

Table of content: (NPI 1972050250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972050250 NPI number — FIGMENT ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIGMENT ENTERPRISES
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:
LOVE & LAUGHTER
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:
1972050250
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
418 S BROADWAY AVE STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75702-8101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-705-7595
Provider Business Mailing Address Fax Number:
903-298-0076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
418 S BROADWAY AVE STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75702-8101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-705-7595
Provider Business Practice Location Address Fax Number:
903-298-0076
Provider Enumeration Date:
09/05/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FOWLER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
CHRISTINE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
903-705-7595

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  65543 , 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)