SCB CLINIC, PLLC , NPI 1558465286 — LAKE JACKSON (TX)

NPI 1558465286

13+ Years Experience Organization

SCB CLINIC, PLLC

09.12.2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1558465286
NPI NUMBER

About SCB CLINIC, PLLC

SCB CLINIC, PLLC is a provider established in LAKE JACKSON, TX. The NPI number of SCB CLINIC, PLLC is 1558465286 and was assigned on 09.12.2006. The practitioners primary taxonomy code is: 261Q00000X with license number: 574974 TX .

Mailing address

  • City: LAKE JACKSON
  • State: TX
  • Postal code: 775665211
  • Phone: 9792978800
  • Fax: 9792970300
  • Address: 207A THAT WAY ST

Primary Practice Address

  • Region : LAKE JACKSON, TX
  • NPI : 1558465286
  • Phone : 9792978800
  • Postalcode : 775665211
  • Address : 207A THAT WAY ST

Provider taxonomy - Clinic/Center

  • Taxonomy code: 261Q00000X
  • License number: 574974
  • License state: TX

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Contacts:

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  • SCB CLINIC, PLLC
  • Address : 207A THAT WAY ST
  • Region : LAKE JACKSON, TX
  • NPI : 1558465286
  • Phone : 9792978800
  • Postalcode : 775665211

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 9792978800
  • Title or position : PROVIDER
  • Credentials : RN FNP-C

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address207A THAT WAY ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameLAKE JACKSON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameTX
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code775665211
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number9792978800
The telephone number associated with the location address of the provider being identified.
NPI1558465286
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1261Q00000X
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Provider Enumeration Date09.12.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)SCB CLINIC, PLLC
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address207A THAT WAY ST
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameLAKE JACKSON
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameTX
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code775665211
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number9792978800
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number9792970300
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameBRADLEY
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameSTEPHANI
The first name of the authorized official
Authorized Official Middle NameCURTIS
The middle name of the authorized official
Authorized Official Title or PositionPROVIDER
The title or position of the authorized official
Authorized Official Name Prefix TextMRS.
Authorized Official Name Prefix Text
Authorized Official Credential TextRN FNP-C
Authorized Official Credential Text
Authorized Official Telephone Number9792978800
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1261Q00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Provider License Number 1574974
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1TX
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
X

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