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General NPI Number Information
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NPI Number | 1891162947
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Entity Type | Organization
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Legal Business Name | Q. M. H. V. INC.
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 9611 PRIVATE ROAD 3826
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City | QUINLAN
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State | TX
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Zip | 75474-3931
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Country | US
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Telephone | 903-356-3777
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Fax |
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Provider Business Mailing Address
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Address Line | 9611 PRIVATE ROAD 3826
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City | QUINLAN
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State | TX
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Zip | 75474-3931
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Country | US
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Telephone | 903-356-3777
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | ROBERT LUKOWICZ
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Credential | PA
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Telephone | 903-356-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA01124
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License Number State | TX
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