1245631613 NPI number — TIN RX 807, INC.

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 1245631613 NPI number — TIN RX 807, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIN RX 807, 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:
TIN RX #807
Provider Other Organization Name Type Code:
3
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:
1245631613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15271 SOUTHWEST FREEWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-955-5700
Provider Business Mailing Address Fax Number:
713-955-6970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15271 SOUTHWEST FREEWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-955-5700
Provider Business Practice Location Address Fax Number:
713-955-6970
Provider Enumeration Date:
09/04/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
415-928-9168

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  29476 , 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)