1881650786 NPI number — REEBA E CHACKO M.D.

Table of content: REEBA E CHACKO M.D. (NPI 1881650786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881650786 NPI number — REEBA E CHACKO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHACKO
Provider First Name:
REEBA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEORGE
Provider Other First Name:
REEBA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881650786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17207 KUYKENDAHL RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77379-8423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-374-8555
Provider Business Mailing Address Fax Number:
281-374-8335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1502 TAUB LOOP
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:
77030-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-970-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2006

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: 2084P0804X , with the licence number:  J1250 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: J1250 , 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: 166156303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8K0021 . This is a "BC/BS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 166156301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166156302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".