1831449230 NPI number — DR. COURTNEY MARIE PRESTON MD

Table of content: DR. COURTNEY MARIE PRESTON MD (NPI 1831449230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831449230 NPI number — DR. COURTNEY MARIE PRESTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESTON
Provider First Name:
COURTNEY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1831449230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10907 MEMORIAL HERMANN DR STE 400
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:
77584-4114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-835-4159
Provider Business Mailing Address Fax Number:
832-243-5423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2950 CULLEN BLVD STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-835-4159
Provider Business Practice Location Address Fax Number:
832-243-5423
Provider Enumeration Date:
09/12/2012

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: 2084N0600X , with the licence number:  P7185 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: P7185 , 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)

  • Identifier: 00106W . This is a "MEDICARE HARRIS COUNTY GRP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153449704 . This is a "MEDICAID GRP TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: D6392 . This is a "RR MEDICARE GRP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0035TD . This is a "BCBSTX GRP PROVIDER RECORD #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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