1861856114 NPI number — SYMEDIC PLLC

Table of content: (NPI 1861856114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861856114 NPI number — SYMEDIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYMEDIC PLLC
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:
1861856114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2245 TEXAS DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-1679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-566-2641
Provider Business Mailing Address Fax Number:
844-308-1082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2245 TEXAS DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-1679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-566-2641
Provider Business Practice Location Address Fax Number:
844-308-1082
Provider Enumeration Date:
04/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ABDUL
Authorized Official First Name:
OLUMUYIWA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
281-566-2641

Provider Taxonomy Codes

  • Taxonomy code: 2084B0040X , with the licence number:  P1954 , 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: P1954 . This is a "TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com