=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275876484
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEATHER INTERNATIONAL GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2013
-----------------------------------------------------
Last Update Date | 02/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9898 BISSONNET ST STE 362
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-822-1555
-----------------------------------------------------
Fax | 281-822-1556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9898 BISSONNET ST 362
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-822-1555
-----------------------------------------------------
Fax | 281-822-1556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MR. AIJAZ HUSSAIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-822-1555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251X00000X
-----------------------------------------------------
Taxonomy Name | Supports Brokerage Agency
-----------------------------------------------------
License Number | 12345AJ
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 12345AJ
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 246X00000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Specialist/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------