1780764050 NPI number — JAMES M KILLIAN MD

Table of content: JAMES M KILLIAN MD (NPI 1780764050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780764050 NPI number — JAMES M KILLIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILLIAN
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1780764050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6501 FANNIN ST STE NB336
Provider Second Line Business Mailing Address:
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:
713-798-5983
Provider Business Mailing Address Fax Number:
713-798-8827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6501 FANNIN ST
Provider Second Line Business Practice Location Address:
NB 336
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-798-4072
Provider Business Practice Location Address Fax Number:
713-798-3854
Provider Enumeration Date:
10/17/2006

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: 2084N0400X , with the licence number:  D6471 , 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: 128879704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128879706 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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