1952348229 NPI number — GERIATRIC HOME CARE PHYSICIANS 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 1952348229 NPI number — GERIATRIC HOME CARE PHYSICIANS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRIC HOME CARE PHYSICIANS 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:
1952348229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17685
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77496-7685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-565-1112
Provider Business Mailing Address Fax Number:
281-565-1102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16605 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-565-1112
Provider Business Practice Location Address Fax Number:
281-565-1102
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAVARE
Authorized Official First Name:
ARUSHA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRINCIPAL PARTNER
Authorized Official Telephone Number:
281-565-1112

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: L7979 , 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: 164648101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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