Healthcare Provider Details

I. General information

NPI: 1508193111
Provider Name (Legal Business Name): EARTH RESOURCES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 LA BRANCH ST
HOUSTON TX
77004-5041
US

IV. Provider business mailing address

4715 LA BRANCH ST
HOUSTON TX
77004-5041
US

V. Phone/Fax

Practice location:
  • Phone: 713-528-7102
  • Fax: 713-528-7102
Mailing address:
  • Phone: 713-528-7102
  • Fax: 713-528-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number1250358
License Number StateTX

VIII. Authorized Official

Name: MRS. TAMIKA LASHUN FLETCHER
Title or Position: PRESIDENT
Credential:
Phone: 832-545-7607