Provider Demographics
NPI:1356015002
Name:T4 INVESTMENT GROUP LLC
Entity Type:Organization
Organization Name:T4 INVESTMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TULLOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:936-224-7135
Mailing Address - Street 1:11133 INTERSTATE 45 S STE 270
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-5835
Mailing Address - Country:US
Mailing Address - Phone:936-224-7135
Mailing Address - Fax:
Practice Address - Street 1:11133 INTERSTATE 45 S STE 270
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77302-5835
Practice Address - Country:US
Practice Address - Phone:936-224-7135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1002764OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES REGULATORY LICENSING UNIT