1629388988 NPI number — CENTER FOR MEDICAL GENETICS, PLLC

Table of content: (NPI 1629388988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629388988 NPI number — CENTER FOR MEDICAL GENETICS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR MEDICAL GENETICS, PLLC
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:
1629388988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7400 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77054-1920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-790-1990
Provider Business Mailing Address Fax Number:
713-790-1903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 SCHOOL ST
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77375-4595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-790-1990
Provider Business Practice Location Address Fax Number:
713-790-1903
Provider Enumeration Date:
10/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
713-790-1990

Provider Taxonomy Codes

  • Taxonomy code: 207SC0300X , with the licence number:  K1699 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207SG0201X , with the licence number: K1699 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085U0001X , with the licence number: K1699 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: K1699 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 020788801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020788802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 058886501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 058886503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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