1255314985 NPI number — TEXAS EAR, NOSE & THROAT SPECIALISTS, PLLC

Table of content: (NPI 1255314985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255314985 NPI number — TEXAS EAR, NOSE & THROAT SPECIALISTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS EAR, NOSE & THROAT 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:
TEXAS EAR NOSE & THROAT SPECIALISTS PA
Provider Other Organization Name Type Code:
5
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:
1255314985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10740 N GESSNER DR
Provider Second Line Business Mailing Address:
STE 310
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77064-1240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-897-0416
Provider Business Mailing Address Fax Number:
281-890-8908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21216 NORTHWEST FREEWAY
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77429-4698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-890-6155
Provider Business Practice Location Address Fax Number:
888-905-2348
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MOORHEAD
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-890-8908

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207YP0228X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YS0012X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YS0123X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YX0901X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 081075603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109364302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 081075602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109364303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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