1760920367 NPI number — GREGORY TESTAMARCK LSA

Table of content: GREGORY TESTAMARCK LSA (NPI 1760920367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760920367 NPI number — GREGORY TESTAMARCK LSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TESTAMARCK
Provider First Name:
GREGORY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSA
Provider Gender Code:
M

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:
1760920367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4411 CHARRITON DR
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:
77039-4709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-526-1849
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 ALDINE MAIL ROUTE RD STE 104
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:
77039-5532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
346-229-4177
Provider Business Practice Location Address Fax Number:
346-229-4190
Provider Enumeration Date:
02/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X , with the licence number:  SA00468 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 1151233 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: SA00721 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8QF483 . This is a "BCBS - UNIVERSAL SURGICAL PARTNERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8PX957 . This is a "BCBS- US MSO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8QA718 . This is a "BCBS - BLUE STAR SURGICAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8QC669 . This is a "BCBS - XCITE SURGICAL ASSISTANTS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8QC851 . This is a "BCBS - UNIVERSAL SURGICAL ASSISTANTS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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