Provider Demographics
NPI:1710377486
Name:NATIONAL PROVIDER SERVICES LLC
Entity Type:Organization
Organization Name:NATIONAL PROVIDER SERVICES LLC
Other - Org Name:NATIONAL PROVIDER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-328-9318
Mailing Address - Street 1:10022 PRAIRIE MIST ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-2241
Mailing Address - Country:US
Mailing Address - Phone:832-328-9318
Mailing Address - Fax:832-328-9318
Practice Address - Street 1:10022 PRAIRIE MIST ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-2241
Practice Address - Country:US
Practice Address - Phone:832-328-9318
Practice Address - Fax:832-328-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care