Provider Demographics
NPI:1639518616
Name:TREBLE CLEF TECHNOLOGIES
Entity Type:Organization
Organization Name:TREBLE CLEF TECHNOLOGIES
Other - Org Name:PREPAID THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-490-3697
Mailing Address - Street 1:3233 TOMAHAWK ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2315
Mailing Address - Country:US
Mailing Address - Phone:915-490-3697
Mailing Address - Fax:
Practice Address - Street 1:3233 TOMAHAWK ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2315
Practice Address - Country:US
Practice Address - Phone:915-490-3697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541611171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX51PK6OtherCAGE CODE FOR WAWF