Provider Demographics
NPI:1952913154
Name:FUNNEL CAKE AND BEIGNET FACTORY
Entity Type:Organization
Organization Name:FUNNEL CAKE AND BEIGNET FACTORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-493-1364
Mailing Address - Street 1:3545 MAINER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-5535
Mailing Address - Country:US
Mailing Address - Phone:713-493-1364
Mailing Address - Fax:
Practice Address - Street 1:3545 MAINER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-5535
Practice Address - Country:US
Practice Address - Phone:713-493-1364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUNNEL CAKE AND BEIGNET FACTORY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)