Provider Demographics
NPI:1821317561
Name:NXTGEN LLC
Entity Type:Organization
Organization Name:NXTGEN LLC
Other - Org Name:NXTGEN HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-251-9367
Mailing Address - Street 1:1570 S DAIRY ASHFORD RD
Mailing Address - Street 2:108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3855
Mailing Address - Country:US
Mailing Address - Phone:832-243-5233
Mailing Address - Fax:832-770-4987
Practice Address - Street 1:1570 S DAIRY ASHFORD RD
Practice Address - Street 2:108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3855
Practice Address - Country:US
Practice Address - Phone:832-243-5233
Practice Address - Fax:832-770-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12731111N00000X
TX271163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5901637OtherNCPDP PROVIDER IDENTIFICATION NUMBER