Provider Demographics
NPI:1063658847
Name:SAFETY EXTENSIONS
Entity Type:Organization
Organization Name:SAFETY EXTENSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-797-1608
Mailing Address - Street 1:4922 WATERFALL ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-1321
Mailing Address - Country:US
Mailing Address - Phone:512-797-1608
Mailing Address - Fax:888-662-4032
Practice Address - Street 1:4922 WATERFALL ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-1321
Practice Address - Country:US
Practice Address - Phone:512-797-1608
Practice Address - Fax:888-662-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-27
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS515999251K00000X, 282J00000X, 302F00000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No282J00000XHospitalsReligious Nonmedical Health Care Institution
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization