1366605016 NPI number — RICHWOOD MEDICAL MANAGEMENT, LLC

Table of content: (NPI 1366605016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366605016 NPI number — RICHWOOD MEDICAL MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHWOOD MEDICAL MANAGEMENT, LLC
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:
ASSURE MEDICAL MANAGEMENT
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:
1366605016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 415
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLUTE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77531-0415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-265-5400
Provider Business Mailing Address Fax Number:
281-271-8688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3231 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77581-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-529-9045
Provider Business Practice Location Address Fax Number:
281-271-8688
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHUSTER
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
979-265-5400

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com