=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043563869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEKTON RESEARCH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2012
-----------------------------------------------------
Last Update Date | 01/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4534 W GATE BLVD SUITE 110
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78745-1485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-388-5717
-----------------------------------------------------
Fax | 512-366-9575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4534 W GATE BLVD SUITE 110
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78745-1485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-388-5717
-----------------------------------------------------
Fax | 512-366-9575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KIP MCKENZIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-388-5717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1744R1102X
-----------------------------------------------------
Taxonomy Name | Research Study Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------