NPI |
1093462061 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Provider Organization Name Legal Business Name |
MY PAL |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
12720 BRANT ROCK DR APT 314 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
HOUSTON |
The first name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address State Name |
TX |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
770825437 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
3462184484 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
3/9/2022 |
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only. |
Last Update Date |
3/15/2022 |
The other abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Authorized Official Last Name |
OLADIMEJI |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
FELIX |
The first name of the authorized official. |
Authorized Official Middle Name |
ADEOLA |
The middle name of the authorized official. |
Authorized Official Title or Position |
CEO |
The title or position of the authorized official. |
Authorized Official Telephone Number |
3462184484 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
343900000X |
The country code in the location address of the provider being identified. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The telephone number associated with the location address of the provider being identified. |
Is Organization Subpart |
N |
The fax number associated with the location
address of the provider being identified. |
Authorized Official Name Prefix Text |
MR. |
The date the provider was assigned a unique identifier (assigned an NPI). |
NPI Certification Date |
3/15/2022 |
|