=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932534104
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TO NEW HEIGHT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2013
-----------------------------------------------------
Last Update Date | 09/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19427 BILLINEYS PARK DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-8536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-780-4483
-----------------------------------------------------
Fax | 187-752-2500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19429 BILLINEYS PARK DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-780-4483
-----------------------------------------------------
Fax | 187-752-2500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANTHONY JEROME WILHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-780-4483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number | N137246015
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------