Provider Demographics
NPI:1063798866
Name:TEXAS J & L MANAGEMENT LLC
Entity type:Organization
Organization Name:TEXAS J & L MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:281-850-1937
Mailing Address - Street 1:3815 OAKWILDE CIR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4496
Mailing Address - Country:US
Mailing Address - Phone:281-850-1937
Mailing Address - Fax:281-842-1794
Practice Address - Street 1:3403 SPENCER HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1107
Practice Address - Country:US
Practice Address - Phone:281-850-1937
Practice Address - Fax:281-842-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776723363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB142655Medicare PIN