1649326208 NPI number — 3 ROBERT LLC

Table of content: MRS. KAREN THAYER DANISH PT (NPI 1407950843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649326208 NPI number — 3 ROBERT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
3 ROBERT LLC
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:
1649326208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78639-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-388-4593
Provider Business Mailing Address Fax Number:
325-388-4594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 RANCH ROAD 2900
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78639-6063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-388-4593
Provider Business Practice Location Address Fax Number:
325-388-4594
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUMPHRIES
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
325-388-4593

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  27621 , 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: 2135557 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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