1164747465 NPI number — ACUTE MEDICAL SERVICES LLC

Table of content: (NPI 1164747465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164747465 NPI number — ACUTE MEDICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACUTE MEDICAL SERVICES LLC
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:
1164747465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77347-5010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15411 VANTAGE PKWY W STE 210
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:
77032-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-831-9944
Provider Business Practice Location Address Fax Number:
713-583-8119
Provider Enumeration Date:
03/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MEADS
Authorized Official First Name:
JODY
Authorized Official Middle Name:
SHANE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-319-8843

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1000391 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 1000391 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P00899083 . This is a "RAILROAD MCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 213546901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: AM1174 . This is a "BCBS OF TX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 017858500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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