=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811336639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXT STEP CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2013
-----------------------------------------------------
Last Update Date | 06/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4615 NORTH FWY SUITE 314
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77022-2917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-888-6488
-----------------------------------------------------
Fax | 281-888-6518
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11719 ABBY RIDGE WAY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77044-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-638-2216
-----------------------------------------------------
Fax | 281-888-6518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. NOAH RANKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-638-2216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------