1629171764 NPI number — TERRY I FALEYE PA-C

Table of content: TERRY I FALEYE PA-C (NPI 1629171764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629171764 NPI number — TERRY I FALEYE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALEYE
Provider First Name:
TERRY
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1629171764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19701 KINGWOOD DR STE 6
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77339-3773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-359-6000
Provider Business Mailing Address Fax Number:
281-359-8006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19701 KINGWOOD DR STE 6
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
KINGWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77339-3773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-359-6000
Provider Business Practice Location Address Fax Number:
281-359-8006
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA04167 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8Y1847 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 189518701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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