Provider Demographics
NPI:1841468931
Name:INGRID EUPHEMIA WEAVER
Entity type:Organization
Organization Name:INGRID EUPHEMIA WEAVER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-380-3400
Mailing Address - Street 1:PO BOX 3104
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-3104
Mailing Address - Country:US
Mailing Address - Phone:832-519-4741
Mailing Address - Fax:
Practice Address - Street 1:1306 MARINA BAY DR
Practice Address - Street 2:APT 203 C
Practice Address - City:CLEAR LAKE SHORES
Practice Address - State:TX
Practice Address - Zip Code:77565-2474
Practice Address - Country:US
Practice Address - Phone:832-519-4741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103056261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN