1609826569 NPI number — HOUSTON INTERNAL MEDICINE SPECIALISTS

Table of content: SAMANTHA JEAN BOYLE M.A., BCBA (NPI 1659042109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609826569 NPI number — HOUSTON INTERNAL MEDICINE SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSTON INTERNAL MEDICINE SPECIALISTS
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:
1609826569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7737 BEECHNUT ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-773-2255
Provider Business Mailing Address Fax Number:
713-773-2277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7737 BEECHNUT ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-773-2255
Provider Business Practice Location Address Fax Number:
713-773-2277
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AGU
Authorized Official First Name:
JOHNSON
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
713-773-2255

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  K9007 , 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: 152481101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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