1548987720 NPI number — ATHANS SURGICAL LLC

Table of content: ATIBA VHEIR VIDATO LPC (NPI 1801249503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548987720 NPI number — ATHANS SURGICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATHANS SURGICAL LLC
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:
1548987720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77378-3005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-227-2457
Provider Business Mailing Address Fax Number:
214-764-0880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15103 TX-75
Provider Second Line Business Practice Location Address:
242
Provider Business Practice Location Address City Name:
WILLIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-227-2457
Provider Business Practice Location Address Fax Number:
214-764-0880
Provider Enumeration Date:
10/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-227-2457

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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