Basic Information
| Provider Information | |||||||||
| NPI: | 1134424757 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PROVIDER SERVICES OF TEXAS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUSITA CHITMAN -ALLEN | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 22119 BRIDGESTONE HAWK CT | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773884663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814339298 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 22119 BRIDGESTONE HAWK CT | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773884663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814339298 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2011 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHITMAN-ALLEN | ||||||||
| AuthorizedOfficialFirstName: | SUSITA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2814339298 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Nurse's Aide |
No ID Information.