1881832384 NPI number — KATY PT CLINIC, L.L.C.

Table of content: (NPI 1881832384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881832384 NPI number — KATY PT CLINIC, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATY PT CLINIC, L.L.C.
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:
1881832384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80964
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70598-0964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-993-0993
Provider Business Mailing Address Fax Number:
337-993-5791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19770 KINGSLAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 300B
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77094-1031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-647-7720
Provider Business Practice Location Address Fax Number:
281-647-7721
Provider Enumeration Date:
01/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VARISCO
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
MANAGING MEMBER/OWNER
Authorized Official Telephone Number:
337-993-0993

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  664840000 , 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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