1922195791 NPI number — LEWIS A LANDSMAN II P.A.

Table of content: LEWIS A LANDSMAN II P.A. (NPI 1922195791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922195791 NPI number — LEWIS A LANDSMAN II P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDSMAN
Provider First Name:
LEWIS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
P.A.
Provider Gender Code:
M

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:
1922195791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 FM 1764 RD
Provider Second Line Business Mailing Address:
STE 190
Provider Business Mailing Address City Name:
LA MARQUE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77568-2826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-886-8964
Provider Business Mailing Address Fax Number:
409-440-8071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2808 61ST ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77551-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-886-8964
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

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: 363A00000X , with the licence number:  PA02821 , 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: DD5409 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: PA02821 . This is a "PHYSICIAN ASST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8Y2310 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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