1326300906 NPI number — VIO MED SERVICES

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 1326300906 NPI number — VIO MED SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIO MED SERVICES
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:
1326300906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19619 TIGRIS SPRINGS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77449-4941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-434-3852
Provider Business Mailing Address Fax Number:
281-398-6163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6430 RICHMOND AVE
Provider Second Line Business Practice Location Address:
STE 370
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77057-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-434-3852
Provider Business Practice Location Address Fax Number:
281-398-6163
Provider Enumeration Date:
06/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ODU
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-434-3852

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1000826 , 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)





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