1497797732 NPI number — WEST WYNDE HEALTH SERVICES INC.

Table of content: (NPI 1497797732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497797732 NPI number — WEST WYNDE HEALTH SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST WYNDE HEALTH SERVICES INC.
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:
1497797732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4707 KNIGHTS BRANCH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-5335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-972-1902
Provider Business Mailing Address Fax Number:
713-972-0272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6201 BONHOMME RD
Provider Second Line Business Practice Location Address:
264
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036-4365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-972-1902
Provider Business Practice Location Address Fax Number:
713-972-0272
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IBIK
Authorized Official First Name:
GLADYS
Authorized Official Middle Name:
ORAGWU
Authorized Official Title or Position:
ADMINISTRATOR/DON
Authorized Official Telephone Number:
713-972-1902

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  010643 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 007637 , 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: 001014829 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001014828 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010643 . This is a "L&CHHS, LHHS, PAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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