1962520510 NPI number — TEXAS ALLIANCE MEDICAL GROUP, PA

Table of content: (NPI 1962520510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962520510 NPI number — TEXAS ALLIANCE MEDICAL GROUP, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS ALLIANCE MEDICAL GROUP, 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:
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:
1962520510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14770 MEMORIAL # 200
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:
77079-5252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-493-5535
Provider Business Mailing Address Fax Number:
281-493-3353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6969 GULF FWY STE 370
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:
77087-2599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-643-0600
Provider Business Practice Location Address Fax Number:
713-641-4229
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALLISON
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
281-977-8372

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080591301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00438N . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080591305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00438N . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080591306 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG5146 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com