1922400043 NPI number — LA PROVIDENCE PEDIATRIC AND FAMILY CLINICS

Table of content: (NPI 1922400043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922400043 NPI number — LA PROVIDENCE PEDIATRIC AND FAMILY CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA PROVIDENCE PEDIATRIC AND FAMILY CLINICS
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:
1922400043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9900 S GESSNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77071-1008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-981-6002
Provider Business Mailing Address Fax Number:
713-909-6002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9900 S GESSNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77071-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-981-6002
Provider Business Practice Location Address Fax Number:
713-909-6002
Provider Enumeration Date:
09/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ONWUDIWE
Authorized Official First Name:
IFEYINWA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
713-981-6002

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  N1405 , 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)





Copyright © 2007-2025 www.npivalidator.com