1588950646 NPI number — BENJAMIN MINTER

Table of content: (NPI 1588950646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588950646 NPI number — BENJAMIN MINTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENJAMIN MINTER
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:
1588950646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24303 ROCKIN SEVEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOCKLEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77447-9295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-213-3087
Provider Business Mailing Address Fax Number:
281-398-3932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16126 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
#230
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-213-3087
Provider Business Practice Location Address Fax Number:
281-398-3932
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MINTER
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-213-3087

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com