1669861944 NPI number — KOURTNEY CLARK PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669861944 NPI number — KOURTNEY CLARK PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOURTNEY CLARK 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:
DIAGNOSTIC SERVICES OF HOUSTON
Provider Other Organization Name Type Code:
3
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:
1669861944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5420 DASHWOOD DR STE 310
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:
77081-5360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-512-1267
Provider Business Mailing Address Fax Number:
713-512-1199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5420 DASHWOOD DR STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77081-5360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-512-1267
Provider Business Practice Location Address Fax Number:
713-512-1199
Provider Enumeration Date:
01/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
KOURTNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-512-1267

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  80468 , 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)





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