Basic Information
Provider Information | |||||||||
NPI: | 1194233965 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEXT LEVEL MV LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NEXT LEVEL URGENT CARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 16107 KENSINGTON DR STE 126 | ||||||||
Address2: |   | ||||||||
City: | SUGAR LAND | ||||||||
State: | TX | ||||||||
PostalCode: | 774794224 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2812010657 | ||||||||
FaxNumber: | 2819734194 | ||||||||
Practice Location | |||||||||
Address1: | 25750 KUYKENDAHL RD | ||||||||
Address2: | STE A | ||||||||
City: | SPRING | ||||||||
State: | TX | ||||||||
PostalCode: | 77373 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2817838162 | ||||||||
FaxNumber: | 7134397995 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/16/2018 | ||||||||
LastUpdateDate: | 01/16/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | VALENCIA | ||||||||
AuthorizedOfficialFirstName: | MARIA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF INFORMATION SERVICES | ||||||||
AuthorizedOfficialTelephone: | 2812010657 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.