Provider Demographics
NPI:1811992324
Name:SECOND SILHOUETTE, INC
Entity type:Organization
Organization Name:SECOND SILHOUETTE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V. PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BULLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-677-3178
Mailing Address - Street 1:5215 KIRBY DR STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-5013
Mailing Address - Country:US
Mailing Address - Phone:713-529-3733
Mailing Address - Fax:713-456-2188
Practice Address - Street 1:5215 KIRBY DR STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-5013
Practice Address - Country:US
Practice Address - Phone:713-529-3733
Practice Address - Fax:713-456-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0529730001Medicare NSC