1407171077 NPI number — NORMANDY URGENT CARE CENTER PA

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 1407171077 NPI number — NORMANDY URGENT CARE CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMANDY URGENT CARE CENTER PA
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:
1407171077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
779 NORMANDY ST
Provider Second Line Business Mailing Address:
SUITE-114
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77015-0779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-453-8900
Provider Business Mailing Address Fax Number:
713-453-8901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
779 NORMANDY ST
Provider Second Line Business Practice Location Address:
SUITE-114
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77015-0779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-893-6214
Provider Business Practice Location Address Fax Number:
718-640-2713
Provider Enumeration Date:
04/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RAUF
Authorized Official First Name:
ABDUR
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
713-893-6214

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  L2584 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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