1568770410 NPI number — TMH PHYSICIAN ORGANIZATION

Table of content: (NPI 1568770410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568770410 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:
1568770410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18400 KATY FREEWAY
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-441-4658
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18400 KATY FREEWAY
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-441-4658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2010

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 AND CEO
Authorized Official Telephone Number:
713-441-7963

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , 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: 6223610009 . This is a "METHODIST UROLOGY DME - WEST HOUSTON" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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