1447689237 NPI number — NLUC PLLC

Table of content: (NPI 1447689237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447689237 NPI number — NLUC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NLUC 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:
1447689237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16107 KENSINGTON DR
Provider Second Line Business Mailing Address:
SUITE 126
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-4224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-201-0657
Provider Business Mailing Address Fax Number:
281-336-0764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5535 MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77007-8021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-391-8533
Provider Business Practice Location Address Fax Number:
713-439-7995
Provider Enumeration Date:
11/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BREEZE
Authorized Official First Name:
JULIET
Authorized Official Middle Name:
STACY
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
281-201-0657

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0096YR . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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