1134433642 NPI number — RIVER OAKS EMERGENCY PHYSICIAN

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 1134433642 NPI number — RIVER OAKS EMERGENCY PHYSICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER OAKS EMERGENCY PHYSICIAN
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:
1134433642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2320 S SHEPHERD DR
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:
77019-7014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-526-2320
Provider Business Mailing Address Fax Number:
713-526-2322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2320 S SHEPHERD 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:
77019-7014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-526-2320
Provider Business Practice Location Address Fax Number:
713-526-2322
Provider Enumeration Date:
07/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LUNA
Authorized Official First Name:
HORTENCIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
713-526-2320

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: 1720009590 . This is a "WESLEY NAHM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1194839530 . This is a "JAIME MIRAVITE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1235364167 . This is a "ALLISON DAUM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1285688093 . This is a "ANGELA LEWIS-TRAYLOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1295849727 . This is a "VICTORIA ALEXANDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1417180324 . This is a "AKBAR AMIRAFSHARI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1417903956 . This is a "HORTENCIA LUNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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