1629048582 NPI number — MAINLAND ANESTHESIA ASSOCIATES, P.A.

Table of content: (NPI 1629048582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629048582 NPI number — MAINLAND ANESTHESIA ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINLAND ANESTHESIA ASSOCIATES, P.A.
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:
1629048582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3945
Provider Second Line Business Mailing Address:
DEPT 576
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77253-3945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-510-8522
Provider Business Mailing Address Fax Number:
949-862-2868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 MEDICAL PARK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DICKINSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-534-1133
Provider Business Practice Location Address Fax Number:
281-534-2190
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PINCHOT
Authorized Official First Name:
HARRISON
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-534-1133

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  H7207 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: H7207 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: H7207 , 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: 00L20G . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 083667801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC8952 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00C30N . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 090123301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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