1891985271 NPI number — SHAMROCK PSYCHIATRIC CLINIC P A

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 1891985271 NPI number — SHAMROCK PSYCHIATRIC CLINIC P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAMROCK PSYCHIATRIC CLINIC 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:
6
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:
1891985271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6420 HILLCROFT ST
Provider Second Line Business Mailing Address:
411
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77081-3190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-988-9911
Provider Business Mailing Address Fax Number:
713-995-4205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 HILLCROFT ST
Provider Second Line Business Practice Location Address:
411
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77081-3190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-988-9911
Provider Business Practice Location Address Fax Number:
713-995-4205
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAVICHANDRAN
Authorized Official First Name:
GURUSWAMI
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
713-988-9911

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  F3588 , 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: 082622401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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