1437575461 NPI number — AMEDCO TEXAS LLC

Table of content: (NPI 1437575461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437575461 NPI number — AMEDCO TEXAS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMEDCO TEXAS LLC
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:
1437575461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8076 W SAHARA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-7930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-881-0022
Provider Business Mailing Address Fax Number:
702-974-3537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4365 N EXPWY
Provider Second Line Business Practice Location Address:
STE. 400
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520-4857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-203-0825
Provider Business Practice Location Address Fax Number:
956-404-0119
Provider Enumeration Date:
03/14/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PERREIRA
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
877-881-0022

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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