1669475075 NPI number — MEDWISE, LTD

Table of content: (NPI 1669475075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669475075 NPI number — MEDWISE, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDWISE, LTD
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:
1669475075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 N SAM HOUSTON PKWY E
Provider Second Line Business Mailing Address:
STE 271
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77060-3333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-934-4500
Provider Business Mailing Address Fax Number:
800-215-4840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 N SAM HOUSTON PKWY E
Provider Second Line Business Practice Location Address:
STE 271
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77060-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-934-4500
Provider Business Practice Location Address Fax Number:
800-215-4840
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEBLANC
Authorized Official First Name:
SONYA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
BILLING ADMINISTRATOR
Authorized Official Telephone Number:
713-934-4500

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 380004100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016679501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100337150B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 440595 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900002031 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100245580B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4582106 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 530690 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1014670270001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 902730 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136931716 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1554928 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200512210A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 091542301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2103557 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 518985 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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