1063721892 NPI number — REGIONAL MEDICAL CONCEPTS

Table of content: (NPI 1063721892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063721892 NPI number — REGIONAL MEDICAL CONCEPTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL MEDICAL CONCEPTS
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:
1063721892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 691363
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:
77269-1363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-397-0397
Provider Business Mailing Address Fax Number:
281-397-6934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2216 HIGHLAND HILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77304-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-419-9133
Provider Business Practice Location Address Fax Number:
281-397-6934
Provider Enumeration Date:
09/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CAPERS
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
936-419-9133

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000606 . This is a "TDH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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