1568444115 NPI number — DR. PHILIP S BLUM MD

Table of content: DR. PHILIP S BLUM MD (NPI 1568444115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568444115 NPI number — DR. PHILIP S BLUM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLUM
Provider First Name:
PHILIP
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1568444115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 GESSNER RD STE 750
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:
77024-2574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-333-6900
Provider Business Mailing Address Fax Number:
713-333-6919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 GESSNER RD STE 750
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:
77024-2574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-338-5616
Provider Business Practice Location Address Fax Number:
713-704-3086
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085N0700X , with the licence number:  J8917 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: J8917 , 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: 00X185 . This is a "MEDICARE GROUP PTAN - BRAZORIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153449704 . This is a "MEDICAID GROUP TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 036006703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB6392 . This is a "RAILROAD MEDICARE GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0035TD . This is a "BLUE CROSS BLUE SHIELD OF TEXAS GROUP RECORD NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01049027 . This is a "RR MDCR PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00106W . This is a "MEDICARE GROUP PTAN - HARRIS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 036006704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8DC608 . This is a "BLUE CROSS BLUE SHIELD OF TEXAS INDIVIDUAL RECORD NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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