1518145762 NPI number — GLORY B. LAWSON

Table of content: (NPI 1518145762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518145762 NPI number — GLORY B. LAWSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLORY B. LAWSON
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:
1518145762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 552
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77406-0014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-493-5520
Provider Business Mailing Address Fax Number:
281-341-1474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19901 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 131
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-6538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-493-5520
Provider Business Practice Location Address Fax Number:
281-341-1474
Provider Enumeration Date:
02/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LAWSON
Authorized Official First Name:
GLORY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
281-493-5520

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0064572 , 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: 156155702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 156155701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 156155703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 531589 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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