1689689556 NPI number — CONTEMPORARY FAMILY MEDICINE TRUST

Table of content: (NPI 1689689556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689689556 NPI number — CONTEMPORARY FAMILY MEDICINE TRUST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONTEMPORARY FAMILY MEDICINE TRUST
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:
1689689556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E BOOTHE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77327-4063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-592-2888
Provider Business Mailing Address Fax Number:
281-361-6322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 EAST BOOTHE
Provider Second Line Business Practice Location Address:
# 100
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77327-4063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-592-2888
Provider Business Practice Location Address Fax Number:
281-361-6322
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STOKES
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
281-592-2888

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  4500921162 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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