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General NPI Number Information
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NPI Number | 1205326022
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Entity Type | Organization
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Legal Business Name | ABACUS IME LLC
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 1240 BLALOCK RD STE 190
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City | HOUSTON
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State | TX
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Zip | 77055-6451
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Country | US
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Telephone | 281-469-2225
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Fax | 888-578-8800
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Provider Business Mailing Address
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Address Line | 24165 W INTERSTATE 10 STE 217-611
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1449
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSHUA J GUTIERREZ
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Credential |
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Telephone | 281-469-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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