1902820368 NPI number — ALLERGY & ENT ASSOCIATES, PLLC

Table of content: (NPI 1902820368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902820368 NPI number — ALLERGY & ENT ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY & ENT ASSOCIATES, 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:
6
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:
1902820368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/21/2021
NPI Reactivation Date:
09/02/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 GEARS ROAD
Provider Second Line Business Mailing Address:
SUITE 420B
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77067-4509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-453-4204
Provider Business Mailing Address Fax Number:
281-874-0212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 CIRCLE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE JACKSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-297-6503
Provider Business Practice Location Address Fax Number:
979-297-7600
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
281-453-4204

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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