1669456133 NPI number — JEFFREY S CHIMENTI MD

Table of content: JEFFREY S CHIMENTI MD (NPI 1669456133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669456133 NPI number — JEFFREY S CHIMENTI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIMENTI
Provider First Name:
JEFFREY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1669456133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10740 N GESSNER DR
Provider Second Line Business Mailing Address:
STE 310
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77064-1240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-897-0416
Provider Business Mailing Address Fax Number:
281-890-8908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9301 PINECROFT DR
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-3182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-362-1368
Provider Business Practice Location Address Fax Number:
281-364-8211
Provider Enumeration Date:
11/30/2005

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: 207Y00000X , with the licence number:  H6115 , 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: 1355539-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223393 . This is a "BEECHSTREET" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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