1770755910 NPI number — PHILLIP R. ADAMS, M.D., P.A.

Table of content: (NPI 1770755910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770755910 NPI number — PHILLIP R. ADAMS, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILLIP R. ADAMS, M.D., 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:
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:
1770755910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6410 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-797-0795
Provider Business Mailing Address Fax Number:
713-704-4055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6410 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-797-0795
Provider Business Practice Location Address Fax Number:
713-704-4055
Provider Enumeration Date:
03/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GARZA
Authorized Official First Name:
JANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SPECIALIST II
Authorized Official Telephone Number:
713-797-0795

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  E6201 , 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: 89770J . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0092K . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 25085 . This is a "AMERICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: B0032720 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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