1255567848 NPI number — DOMINION MEDICAL HEALTHCARE SERVICE

Table of content: (NPI 1255567848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255567848 NPI number — DOMINION MEDICAL HEALTHCARE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOMINION MEDICAL HEALTHCARE SERVICE
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:
Provider Other Organization Name Type Code:
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:
1255567848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 BISSONNET ST
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77074-3900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-974-4400
Provider Business Mailing Address Fax Number:
281-974-4386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 BISSONNET ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-974-4400
Provider Business Practice Location Address Fax Number:
281-974-4386
Provider Enumeration Date:
06/09/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
IRENONA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
281-974-4400

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 247100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA 03172 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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