1265484356 NPI number — BRUCE'S MARKET BASKET, LTD.

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 1265484356 NPI number — BRUCE'S MARKET BASKET, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUCE'S MARKET BASKET, LTD.
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:
1265484356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1717
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEDERLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77627-1717
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:
6001 39TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77619-4651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-749-6405
Provider Business Practice Location Address Fax Number:
409-749-6505
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
SKYLAR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
409-727-3104

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  20885 , 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: 143495 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com