1831485119 NPI number — NEW CANEY URGENT CARE CENTER, PA

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 1831485119 NPI number — NEW CANEY URGENT CARE CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW CANEY URGENT CARE CENTER, PA
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:
1831485119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CANEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77357-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-569-0045
Provider Business Mailing Address Fax Number:
281-399-5677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20185 US HIGHWAY 59
Provider Second Line Business Practice Location Address:
SUITE 76
Provider Business Practice Location Address City Name:
NEW CANEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77357-8358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-569-0045
Provider Business Practice Location Address Fax Number:
281-399-5677
Provider Enumeration Date:
06/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WILLENS
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
713-569-0045

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  G9676 , 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)





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