1114318128 NPI number — KATY PREMIER ANESTHESIA PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114318128 NPI number — KATY PREMIER ANESTHESIA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATY PREMIER ANESTHESIA PLLC
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:
1114318128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3918 BROWNING ST
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:
77005-2042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-728-3107
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21720 KINGSLAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77450-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-492-1234
Provider Business Practice Location Address Fax Number:
281-579-5630
Provider Enumeration Date:
02/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CASTRO
Authorized Official First Name:
MELINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-728-3107

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  G8534 , 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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