1023091345 NPI number — CITY OF LORENZO

Table of content: (NPI 1023091345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023091345 NPI number — CITY OF LORENZO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LORENZO
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:
CITY OF LORENZO EMS
Provider Other Organization Name Type Code:
3
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:
1023091345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 BISSONNET ST
Provider Second Line Business Mailing Address:
STE 205
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77074-3900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-773-4355
Provider Business Mailing Address Fax Number:
713-773-4363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 5TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORENZO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79343-0430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-634-5596
Provider Business Practice Location Address Fax Number:
806-634-5597
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LIVELY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
806-634-5596

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  054004 , 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: 086518001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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