1154745651 NPI number — THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON

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 1154745651 NPI number — THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
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:
UTHEALTH DENTISTRY GREENSPOINT
Provider Other Organization Name Type Code:
3
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:
1154745651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 CAMBRIDGE ST
Provider Second Line Business Mailing Address:
SUITE 3510
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77054-2032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-486-4111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 N SAM HOUSTON PKWY W
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77067-4338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-828-1446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TRIEU
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PATIENT SERVICES
Authorized Official Telephone Number:
713-486-4242

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , 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: 349191211 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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