1437452638 NPI number — PEARLAND BACK AND NECK CLINIC

Table of content: (NPI 1437452638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437452638 NPI number — PEARLAND BACK AND NECK CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEARLAND BACK AND NECK CLINIC
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:
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:
1437452638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10950 MEMORIAL HERMANN DR
Provider Second Line Business Mailing Address:
STE 203
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-347-7246
Provider Business Mailing Address Fax Number:
281-347-7250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10950 MEMORIAL HERMANN DR
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-347-7246
Provider Business Practice Location Address Fax Number:
281-347-7250
Provider Enumeration Date:
12/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
ABRAHAM
Authorized Official Middle Name:
GREGORY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-347-7246

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  J1578 , 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: TXB104569 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com