Provider Demographics
NPI:1144669623
Name:FLA CO, LTD
Entity type:Organization
Organization Name:FLA CO, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-332-9676
Mailing Address - Street 1:450 W MEDICAL CENTER BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4229
Mailing Address - Country:US
Mailing Address - Phone:281-332-9676
Mailing Address - Fax:281-338-7723
Practice Address - Street 1:450 W MEDICAL CENTER BLVD STE 206
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4229
Practice Address - Country:US
Practice Address - Phone:281-332-9676
Practice Address - Fax:281-338-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty