Provider Demographics
NPI:1023184884
Name:SECOND SILHOUETTE, INC
Entity Type:Organization
Organization Name:SECOND SILHOUETTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-529-3733
Mailing Address - Street 1:13144 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-7200
Mailing Address - Country:US
Mailing Address - Phone:713-935-9390
Mailing Address - Fax:713-935-0730
Practice Address - Street 1:13144 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-7200
Practice Address - Country:US
Practice Address - Phone:713-935-9390
Practice Address - Fax:713-935-0730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SECOND SILHOUETTE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-25
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0529730003Medicare NSC