1326686494 NPI number — CODE 1 CONCIERGE PLLC

Table of content: (NPI 1326686494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326686494 NPI number — CODE 1 CONCIERGE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CODE 1 CONCIERGE PLLC
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:
1326686494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14101 US 290 W
Provider Second Line Business Mailing Address:
SUITE 400B
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78737-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-894-5050
Provider Business Mailing Address Fax Number:
512-894-2201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14101 US 290 W
Provider Second Line Business Practice Location Address:
SUITE 400B
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78737-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-894-5050
Provider Business Practice Location Address Fax Number:
512-894-2201
Provider Enumeration Date:
12/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
WHITNEY-CASHIO
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
512-894-5050

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P4397 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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