1235183096 NPI number — TMH PHYSICIAN ORGANIZATION

Table of content: (NPI 1235183096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235183096 NPI number — TMH PHYSICIAN ORGANIZATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TMH PHYSICIAN ORGANIZATION
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:
1235183096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6550 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE 447
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-441-7389
Provider Business Mailing Address Fax Number:
713-793-7012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6550 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE 447
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-441-7389
Provider Business Practice Location Address Fax Number:
713-793-7012
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXEC VP & CMO-HMHS,PRESCEO-HMSPG
Authorized Official Telephone Number:
713-441-7389

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 179960301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172037703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0095LZ . This is a "MAIN BCBS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 207803201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172037701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 330448701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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