1285644989 NPI number — JEANNETTE E. BURG

Table of content: (NPI 1285644989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285644989 NPI number — JEANNETTE E. BURG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEANNETTE E. BURG
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:
1285644989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9810 FM 1960 BYPASS RD W
Provider Second Line Business Mailing Address:
# 190
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77338-3502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-446-0371
Provider Business Mailing Address Fax Number:
281-446-4299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9810 FM 1960 BYPASS RD W
Provider Second Line Business Practice Location Address:
# 190
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-446-0371
Provider Business Practice Location Address Fax Number:
281-446-4299
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURG
Authorized Official First Name:
JEANNETTE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER/OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
281-446-0371

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1467488502 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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