1124344940 NPI number — UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER HOUST

Table of content: (NPI 1124344940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124344940 NPI number — UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER HOUST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER HOUST
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:
1124344940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 E. HOLCOMBE BLVD.
Provider Second Line Business Mailing Address:
ATTENTION BENEFITS
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-500-3261
Provider Business Mailing Address Fax Number:
713-500-3263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6641 GRAND BLVD.
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:
77021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-500-3261
Provider Business Practice Location Address Fax Number:
713-500-3263
Provider Enumeration Date:
04/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PARNELL
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
YVETTE
Authorized Official Title or Position:
CLINIC COORDINATOR
Authorized Official Telephone Number:
713-500-3255

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  RN558719 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0100X , with the licence number: K3050 , 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)





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