Provider Demographics
NPI:1699957092
Name:MAJESTIC SPRINGS, LLC
Entity type:Organization
Organization Name:MAJESTIC SPRINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V.P. OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-980-6799
Mailing Address - Street 1:4660 SWEETWATER BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3166
Mailing Address - Country:US
Mailing Address - Phone:281-980-6799
Mailing Address - Fax:281-980-8157
Practice Address - Street 1:4660 SWEETWATER BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3166
Practice Address - Country:US
Practice Address - Phone:281-980-6799
Practice Address - Fax:281-980-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2159207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U7708OtherBCBS