1851642482 NPI number — ESCOBAR-DAVIS MEDICAL MANAGEMENT PLLC

Table of content: (NPI 1851642482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851642482 NPI number — ESCOBAR-DAVIS MEDICAL MANAGEMENT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESCOBAR-DAVIS MEDICAL MANAGEMENT PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1851642482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4003 ALSHIRE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77373-8811
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:
4003 ALSHIRE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77373-8811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-526-5578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ESCOBAR
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER/PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
832-517-6032

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA01488 , 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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