Provider Demographics
NPI:1073207809
Name:ACTIVE MINDS RX PLLC
Entity type:Organization
Organization Name:ACTIVE MINDS RX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KAZMIR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:713-816-5646
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:HUNGERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77448-0511
Mailing Address - Country:US
Mailing Address - Phone:713-816-5646
Mailing Address - Fax:
Practice Address - Street 1:210 E LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:HUNGERFORD
Practice Address - State:TX
Practice Address - Zip Code:77448-0135
Practice Address - Country:US
Practice Address - Phone:713-816-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty