1699018432 NPI number — CLEARCHOICE HEALTHCARE INC

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 1699018432 NPI number — CLEARCHOICE HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEARCHOICE HEALTHCARE INC
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:
1699018432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 ALDINE MAIL ROUTE
Provider Second Line Business Mailing Address:
SUITE
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77039-5524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-557-5546
Provider Business Mailing Address Fax Number:
281-484-3824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 ALDINE MAIL ROUTE
Provider Second Line Business Practice Location Address:
SUITE
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77039-5524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-557-5546
Provider Business Practice Location Address Fax Number:
281-484-3824
Provider Enumeration Date:
03/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
OJEAGA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
713-557-5546

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 801728871 . This is a "CERTIFICATE OF FORMATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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