1174576698 NPI number — CHCA BAYSHORE LP

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 1174576698 NPI number — CHCA BAYSHORE LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHCA BAYSHORE LP
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:
1174576698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 SPENCER HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77504-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-359-1000
Provider Business Mailing Address Fax Number:
713-359-1004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 SPENCER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-359-1000
Provider Business Practice Location Address Fax Number:
713-359-1004
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAGOULAS
Authorized Official First Name:
DEMETRI
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
281-440-1000

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 374018500 . This is a "US DEPT LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 564889 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH0541 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 020817501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117736 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012909800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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