1578104352 NPI number — LYMPHEDEMA THERAPY SPECIALISTS INC.

Table of content: (NPI 1578104352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578104352 NPI number — LYMPHEDEMA THERAPY SPECIALISTS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYMPHEDEMA THERAPY SPECIALISTS 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:
1578104352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2385 W BELLFORT AVE.
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77054-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-497-5335
Provider Business Mailing Address Fax Number:
833-891-3211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2385 W BELLFORT AVE.
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-497-5335
Provider Business Practice Location Address Fax Number:
833-891-3211
Provider Enumeration Date:
10/03/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
832-930-9819

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com