1497788830 NPI number — DIAGNOSTIC NEUROLOGY CLINIC OF HOUSTON PA

Table of content: (NPI 1497788830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497788830 NPI number — DIAGNOSTIC NEUROLOGY CLINIC OF HOUSTON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC NEUROLOGY CLINIC OF HOUSTON 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:
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:
1497788830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 GESSNER
Provider Second Line Business Mailing Address:
SUITE 480
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-467-8491
Provider Business Mailing Address Fax Number:
713-461-6118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 FROSTWOOD DR STE 143
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:
77024-2433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-467-8491
Provider Business Practice Location Address Fax Number:
713-461-6119
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YI
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
713-467-8491

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  G7874 , 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)





Copyright © 2007-2025 www.npivalidator.com