1851415020 NPI number — HEALTH & WELLNESS CLINIC, PA

Table of content: (NPI 1851415020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851415020 NPI number — HEALTH & WELLNESS CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH & WELLNESS CLINIC, PA
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:
1851415020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23920 KATY FWY STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-0883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-665-8498
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23920 KATY FWY STE 550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77494-0883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-665-8498
Provider Business Practice Location Address Fax Number:
281-665-8503
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AL-KHUSH
Authorized Official First Name:
AHMAD-RABIA
Authorized Official Middle Name:
SULAIMAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-665-8498

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  L2086 , 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: 154488401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com