1104045699 NPI number — CHG CORNERSTONE HOSPITAL OF HOUSTON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104045699 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:
Provider Other Organization Name Type Code:
6
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:
1104045699
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:
5314 DASHWOOD DR
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:
77081-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-295-5300
Provider Business Practice Location Address Fax Number:
713-295-5301
Provider Enumeration Date:
04/24/2007

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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