1083668685 NPI number — CHG CORNERSTONE HOSPITAL OF HOUSTON

Table of content: (NPI 1083668685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083668685 NPI number — CHG CORNERSTONE HOSPITAL OF HOUSTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHG CORNERSTONE HOSPITAL OF HOUSTON
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:
CORNERSTONE HOSPITAL OF HOUSTON AT CLEARLAKE
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:
1083668685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 ROSS AVE
Provider Second Line Business Mailing Address:
SUITE 5400
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75201-2708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-621-6700
Provider Business Mailing Address Fax Number:
469-621-6672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77598-4005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-332-3322
Provider Business Practice Location Address Fax Number:
281-316-1478
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
CENTRAL BUSINESS OFFICE DIRECTOR
Authorized Official Telephone Number:
469-621-6716

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  008282 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0210130-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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