1861537730 NPI number — GREATER HOUSTON ONCOLOGY PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861537730 NPI number — GREATER HOUSTON ONCOLOGY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER HOUSTON ONCOLOGY PA
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:
1861537730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3304 MILAM ST
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:
77006-3618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-524-5030
Provider Business Mailing Address Fax Number:
713-524-4508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3304 MILAM ST
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:
77006-3618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-524-5030
Provider Business Practice Location Address Fax Number:
713-524-4508
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
TH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-524-5030

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000678R . This is a "BLUE SHIELD GRP BILLING N" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1503757-1 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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