1568423200 NPI number — MS. CLAIRE H CHANG MD PA

Table of content: MS. CLAIRE H CHANG MD PA (NPI 1568423200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568423200 NPI number — MS. CLAIRE H CHANG MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANG
Provider First Name:
CLAIRE
Provider Middle Name:
H
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD PA
Provider Gender Code:
F

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:
1568423200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4346
Provider Second Line Business Mailing Address:
DEPT 521
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77210-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-580-2500
Provider Business Mailing Address Fax Number:
713-580-2597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5115 MAIN ST
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:
77002-9749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-580-2500
Provider Business Practice Location Address Fax Number:
713-580-2597
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  L0072 , 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: 0069GX . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 144535503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 144535504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174671101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180042438 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00220702 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DD3155 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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