Provider Demographics
NPI:1972771715
Name:SUSAN K. PANZARELLA
Entity type:Organization
Organization Name:SUSAN K. PANZARELLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PANZARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-446-7771
Mailing Address - Street 1:9652 FM 1960 BYPASS RD W
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4039
Mailing Address - Country:US
Mailing Address - Phone:281-446-7771
Mailing Address - Fax:281-446-7701
Practice Address - Street 1:9652 FM 1960 BYPASS RD W
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4039
Practice Address - Country:US
Practice Address - Phone:281-446-7771
Practice Address - Fax:281-446-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162449602Medicaid
TX162449601Medicaid
TXV16521OtherHOMELINK
TX531483OtherBCBS
TX531601OtherBCBS
TX531601OtherBCBS