1083605604 NPI number — NEX-MED INC

Table of content: (NPI 1083605604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083605604 NPI number — NEX-MED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEX-MED INC
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:
6
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:
1083605604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2747
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77402-2747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-893-9994
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6610 HARWIN DR STE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036-2237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-208-7776
Provider Business Practice Location Address Fax Number:
832-201-8854
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
JEROME
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
AMBULANCE COMPANY OWNER
Authorized Official Telephone Number:
832-548-0412

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 166750301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00139349 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: AMB746 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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