1851470223 NPI number — DR. TIANA M SHIVER MD

Table of content: DR. TIANA M SHIVER MD (NPI 1851470223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851470223 NPI number — DR. TIANA M SHIVER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIVER
Provider First Name:
TIANA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHIVER
Provider Other First Name:
TIANA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD PA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1851470223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 FROSTWOOD DR STE 1.100
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:
77024-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-338-6353
Provider Business Mailing Address Fax Number:
713-704-3086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 FANNIN ST STE 2015
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:
77030-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-658-4050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2006

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: 207RE0101X , with the licence number:  H2780 , 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: 00T68N . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".