1396726709 NPI number — NORTHWEST INTERNAL MEDICINE SPECIALISTS PLLC

Table of content: (NPI 1396726709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396726709 NPI number — NORTHWEST INTERNAL MEDICINE SPECIALISTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST INTERNAL MEDICINE SPECIALISTS PLLC
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:
1396726709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 73105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77273-3105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-890-6800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13311 HARGRAVE RD STE 103
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:
77070-4310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-890-6800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POONAWALA
Authorized Official First Name:
ASHIQUEALI
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-890-6800

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 080905501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".