1891800892 NPI number — MALCOLM H. BREMER, M.D., P.A.

Table of content: (NPI 1891800892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891800892 NPI number — MALCOLM H. BREMER, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MALCOLM H. BREMER, M.D., P.A.
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:
1891800892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18955 N MEMORIAL DR STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77338-4269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-446-6464
Provider Business Mailing Address Fax Number:
281-446-7869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18955 N MEMORIAL DR STE 550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-4269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-446-6464
Provider Business Practice Location Address Fax Number:
281-446-7869
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BREMER
Authorized Official First Name:
MALCOLM
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-446-6464

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  E5010 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: E5010 , 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: 061900224 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 156055901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10015423 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 74066451 77338 A001 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 133933503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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