1285645770 NPI number — ARTHUR D ABERNATHY

Table of content: (NPI 1285645770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285645770 NPI number — ARTHUR D ABERNATHY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTHUR D ABERNATHY
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:
MEDICAL PLAZA
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:
1285645770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 CRAWFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77002-8942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-654-4137
Provider Business Mailing Address Fax Number:
713-654-4138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 CRAWFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002-8942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-654-4137
Provider Business Practice Location Address Fax Number:
713-654-4138
Provider Enumeration Date:
08/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ABERNATHY
Authorized Official First Name:
ART
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
713-654-4137

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 12246 , 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: 2096956 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 143067 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".