1497776017 NPI number — TMH PHYSICIAN ORGANIZATION

Table of content: (NPI 1497776017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497776017 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:
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:
1497776017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6565 FANNIN ST
Provider Second Line Business Mailing Address:
D200
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-790-2221
Provider Business Mailing Address Fax Number:
713-793-7092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6560 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-441-3800
Provider Business Practice Location Address Fax Number:
713-793-1015
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOSTMAN
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
DIRK
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
713-790-2221

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 173088901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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