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General NPI Number Information
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NPI Number | 1265966196
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Entity Type | Organization
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Legal Business Name | ADMIRABLE PROVIDER SERVICES LLC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 13202 BRIAR FOREST DR APT 4264
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City | HOUSTON
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State | TX
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Zip | 77077-2458
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Country | US
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Telephone | 832-602-6212
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Fax |
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Provider Business Mailing Address
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Address Line | 13202 BRIAR FOREST DR APT 4264
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City | HOUSTON
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State | TX
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Zip | 77077-2458
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Country | US
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Telephone | 832-602-6212
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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. CYRUS BENJAMIN WASHINGTON JR.
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Credential |
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Telephone | 832-602-6212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State | TX
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