1699070672 NPI number — LYMPHEDEMA INSTITUTE, INC.

Table of content: (NPI 1699070672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699070672 NPI number — LYMPHEDEMA INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYMPHEDEMA INSTITUTE, 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:
6
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:
1699070672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 WESTCOTT ST
Provider Second Line Business Practice Location Address:
470
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-526-7926
Provider Business Practice Location Address Fax Number:
713-864-7928
Provider Enumeration Date:
01/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ADOLF
Authorized Official First Name:
JOEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-526-7926

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  102359 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00S5S8 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 145602203 . This is a "DR SHARE - MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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