1871270850 NPI number — DR. GINGER SELLARS KAASJAGER, DPM PLLC

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 1871270850 NPI number — DR. GINGER SELLARS KAASJAGER, DPM PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. GINGER SELLARS KAASJAGER, DPM 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:
1871270850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
242 OVERLAND TRCE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77316-6401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-537-5714
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 FISH CREEK THOROUGHFARE STE 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77316-6966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-537-5714
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SELLARS
Authorized Official First Name:
GINGER
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
936-537-5714

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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