1912180068 NPI number — GENEE' MARRIOTT- EMFINGER LSA, CSA, RTR

Table of content: (NPI 1346811023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912180068 NPI number — GENEE' MARRIOTT- EMFINGER LSA, CSA, RTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARRIOTT- EMFINGER
Provider First Name:
GENEE'
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSA, CSA, RTR
Provider Gender Code:
F

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:
1912180068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8556
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77387-8556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-494-8266
Provider Business Mailing Address Fax Number:
936-582-4445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 PINECROFT DR.
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-494-8266
Provider Business Practice Location Address Fax Number:
936-582-4445
Provider Enumeration Date:
12/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X , with the licence number:  SA00358 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZX2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZS0410X , with the licence number: 487388 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246Z00000X , with the licence number: 06-325 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471C3402X , with the licence number: 12877 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 247100000X , with the licence number: 12877 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: SA00358 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: SA00358 . This is a "LSA LICENSE - TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 487388 . This is a "NCCT CETIFICATION - TECH IN SURGERY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06-325 . This is a "CERTFICATION - AMERICAN BOARD OF SURGICAL ASSISTANTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12877 . This is a "TEXAS MEDICAL BOARD - RADIOLOGIC TECHNOLOGIST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".