1023086709 NPI number — GREATER HOUSTON EMERGENCY PHYSICIANS PLLC

Table of content: (NPI 1023086709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023086709 NPI number — GREATER HOUSTON EMERGENCY PHYSICIANS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER HOUSTON EMERGENCY PHYSICIANS 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:
1023086709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 301039
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75303-1039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-784-1500
Provider Business Mailing Address Fax Number:
281-209-8930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13402 SAN PEDRO BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-539-1111
Provider Business Practice Location Address Fax Number:
409-788-8044
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEAY
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
281-784-1111

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080402305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0046DE . This is a "BCBSTX GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 182797400 . This is a "DOL OWCP GRP PROV NO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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