1154344596 NPI number — CANAL FAMILY AND INDUSTRIAL MEDICINE P.A.

Table of content: (NPI 1154344596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154344596 NPI number — CANAL FAMILY AND INDUSTRIAL MEDICINE P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANAL FAMILY AND INDUSTRIAL MEDICINE P.A.
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:
1154344596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3003 NAVIGATION BLVD
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:
77003-1239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-223-4466
Provider Business Mailing Address Fax Number:
713-223-1571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 NAVIGATION BLVD
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:
77003-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-223-4466
Provider Business Practice Location Address Fax Number:
713-223-1571
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUARTE
Authorized Official First Name:
JAIME
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
713-223-4466

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10011602 . This is a "DUARTE AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 163266301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 182946701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163266302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7948658 . This is a "MONCAYO AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8S0531 . This is a "BLUE CROSS MONCAYO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 182946702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 182946703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7893532 . This is a "DUARTE AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8S0530 . This is a "BLUE CROSS DUARTE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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