1588768212 NPI number — THE CENTER FOR OPTIMUM WELLNESS PA

Table of content: (NPI 1588768212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588768212 NPI number — THE CENTER FOR OPTIMUM WELLNESS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CENTER FOR OPTIMUM WELLNESS 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:
1588768212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5433 WESTHEIMER RD
Provider Second Line Business Mailing Address:
SUITE 411
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77056-5322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-623-6305
Provider Business Mailing Address Fax Number:
713-840-7909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5433 WESTHEIMER RD
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77056-5322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-623-6305
Provider Business Practice Location Address Fax Number:
713-840-7909
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLLIER
Authorized Official First Name:
NORRI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-623-6305

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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