1174576698 NPI number — CHCA BAYSHORE LP

Table of content: (NPI 1174576698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174576698 NPI number — CHCA BAYSHORE LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHCA BAYSHORE LP
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:
1174576698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 SPENCER HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77504-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-359-1000
Provider Business Mailing Address Fax Number:
713-359-1004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 SPENCER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-359-1000
Provider Business Practice Location Address Fax Number:
713-359-1004
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAGOULAS
Authorized Official First Name:
DEMETRI
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
281-440-1000

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 374018500 . This is a "US DEPT LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 564889 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH0541 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 020817501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117736 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012909800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com