1356323943 NPI number — DR. KATHLEEN H. EBERLE MD

Table of content: DR. KATHLEEN H. EBERLE MD (NPI 1356323943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356323943 NPI number — DR. KATHLEEN H. EBERLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBERLE
Provider First Name:
KATHLEEN
Provider Middle Name:
H.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1356323943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4141 VISTA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77504-2113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-947-3100
Provider Business Mailing Address Fax Number:
713-947-6103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10905 MEMORIAL HERMANN DR
Provider Second Line Business Practice Location Address:
STE 115
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584-3490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-947-3100
Provider Business Practice Location Address Fax Number:
713-704-1796
Provider Enumeration Date:
11/18/2005

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: 2084N0400X , with the licence number:  L1025 , 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: DB6392 . This is a "RAILROAD MEDICARE GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00106W . This is a "MEDICARE GROUP PTAN - HARRIS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00X185 . This is a "MEDICARE GROUP PTAN - BRAZORIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153449704 . This is a "MEDICAID GROUP TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8DC609 . This is a "BLUE CROSS BLUE SHIELD INDIVIDUAL RECORD NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0035TD . This is a "BLUE CROSS BLUE SHIELD OF TEXAS GROUP RECORD NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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