1467558510 NPI number — DR. STEVEN KYLE PERILMAN MD

Table of content: DR. STEVEN KYLE PERILMAN MD (NPI 1467558510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467558510 NPI number — DR. STEVEN KYLE PERILMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERILMAN
Provider First Name:
STEVEN
Provider Middle Name:
KYLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERILMAN
Provider Other First Name:
STEVEN
Provider Other Middle Name:
KYLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467558510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CORPORATE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508-3870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-893-9698
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6621 FANNIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-824-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2006

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: 207P00000X , with the licence number:  J4430 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207PP0204X , with the licence number: J4430 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0204X , with the licence number: J4430 , 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: 134992008 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121320100 . This is a "FIRSTCARE PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 137283103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5040636 . This is a "AETNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 137345805 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4731603 . This is a "CIGNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10022295 . This is a "AMERIGROUP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00L42V . This is a "BCBSTX GRP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 108867 . This is a "SUPERIOR PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1669442042 . This is a "GRP NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1854186 . This is a "FIRSTHEALTH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 88629X . This is a "BCBSTX IND PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 134992007 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1415257 . This is a "UHC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com