1043431521 NPI number — CHARLES G HOLMSTEN MD AND ASSOCIATES

Table of content: (NPI 1043431521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043431521 NPI number — CHARLES G HOLMSTEN MD AND ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES G HOLMSTEN MD AND ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRAESWOOD AND PASADENA AND RICHMOND ROSENBERG CLINICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043431521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7545 S BRAESWOOD BLVD
Provider Second Line Business Mailing Address:
117 LANE DR TX 77471 AND 3122 SPENCER HWY TX 77504
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77071-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-777-3131
Provider Business Mailing Address Fax Number:
713-777-5544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7545 S BRAESWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77071-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-777-3131
Provider Business Practice Location Address Fax Number:
713-777-5544
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMSTEN
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER AND SEL PROPRIETOR
Authorized Official Telephone Number:
713-777-3131

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X , with the licence number:  L8734 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207QA0505X , with the licence number: D6035 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207QA0505X , with the licence number: L8535 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207QA0505X , with the licence number: K7677 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QX0100X , with the licence number: D6035 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QX0100X , with the licence number: L8734 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QX0100X , with the licence number: L8535 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QX0100X , with the licence number: K7677 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 108343 . This is a "AMERIGROUP M E BUXBAUM,DO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 57420H . This is a "BC BS GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8M5130 . This is a "BC BS WALTER R HOLMSTEN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F5610 . This is a "BC BS M E BUXBAUM, DO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84V645 . This is a "BC BS CHARLES G HOLMSTEN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 25422 . This is a "AMERIGROUP C G HOLMSTEN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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