Provider Demographics
NPI:1639671084
Name:WHITAKER ENTERPRISE CONTRACTOR
Entity type:Organization
Organization Name:WHITAKER ENTERPRISE CONTRACTOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-641-0240
Mailing Address - Street 1:719 WHEELHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5829
Mailing Address - Country:US
Mailing Address - Phone:832-641-0240
Mailing Address - Fax:281-208-0247
Practice Address - Street 1:719 WHEELHOUSE DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5829
Practice Address - Country:US
Practice Address - Phone:832-641-0240
Practice Address - Fax:281-208-0247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITAKER ENTERPRISE CONTRACTOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-01
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid