1265596993 NPI number — MS. KAREN MITSCHELL HAMID PT

Table of content: MS. KAREN MITSCHELL HAMID PT (NPI 1265596993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265596993 NPI number — MS. KAREN MITSCHELL HAMID PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMID
Provider First Name:
KAREN
Provider Middle Name:
MITSCHELL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOGAN
Provider Other First Name:
KAREN
Provider Other Middle Name:
MITSCHELL
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265596993
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18618
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:
77496-8618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-804-0619
Provider Business Mailing Address Fax Number:
281-545-9970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
ROSENBERG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77471-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-804-0619
Provider Business Practice Location Address Fax Number:
281-545-9970
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1082881 , 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: 1265596993 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 364618156 . This is a "GREAT WEST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8T1541 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1766347-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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