1215200704 NPI number — KLEENEX EMS, INC

Table of content: (NPI 1215200704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215200704 NPI number — KLEENEX EMS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KLEENEX EMS, 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:
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:
1215200704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5925 PHELAN BLVD # I
Provider Second Line Business Mailing Address:
SUITE 175
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77706-6253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-860-4576
Provider Business Mailing Address Fax Number:
832-350-7894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5925 PHELAN BLVD # I
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77706-6253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-860-4576
Provider Business Practice Location Address Fax Number:
832-350-7894
Provider Enumeration Date:
02/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
AKAMO
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
GBENGA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
409-860-4576

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1000736 , 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)

  • Identifier: 1000736 . This is a "TEXAS DEPARTMENT OF STATE HEALTH SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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