1649564535 NPI number — SONAS INFUSION CENTER, LLC

Table of content: (NPI 1649564535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649564535 NPI number — SONAS INFUSION CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SONAS INFUSION CENTER, 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:
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:
1649564535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2065
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:
77252-2065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-820-1900
Provider Business Mailing Address Fax Number:
281-820-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 MAIN AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-247-2500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BLANTON
Authorized Official First Name:
RENAE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER / MANAGER
Authorized Official Telephone Number:
970-247-2500

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  186468 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 186468 . This is a "STATE LICENSURE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com