1609199009 NPI number — GOOD SHEPHERD EMS INC

Table of content: DAVID JAMES HENDREN APRN (NPI 1710572466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609199009 NPI number — GOOD SHEPHERD EMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SHEPHERD EMS 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:
1609199009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36131
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77236-6131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-830-8793
Provider Business Mailing Address Fax Number:
832-242-2274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6610 HARWIN DR
Provider Second Line Business Practice Location Address:
218
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036-2232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-748-2124
Provider Business Practice Location Address Fax Number:
832-242-2274
Provider Enumeration Date:
03/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ONYEKWELU
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
UCHE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-748-2124

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000480 . This is a "TDSHS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2147076 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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