Provider Demographics
NPI:1689784670
Name:1866ICPAYDAY.COM LLC
Entity Type:Organization
Organization Name:1866ICPAYDAY.COM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:T
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-884-0498
Mailing Address - Street 1:1801 S DAIRY ASHFORD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4765
Mailing Address - Country:US
Mailing Address - Phone:832-884-0498
Mailing Address - Fax:
Practice Address - Street 1:1801 S DAIRY ASHFORD ST STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4765
Practice Address - Country:US
Practice Address - Phone:832-884-0498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0091229332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1834509Medicaid
5769430001Medicare NSC