1982895744 NPI number — GREATER HOUSTON HEART SPECIALISTS P.A.

Table of content: ELLEN RENEE THOMPSON PNP (NPI 1902446164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982895744 NPI number — GREATER HOUSTON HEART SPECIALISTS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER HOUSTON HEART SPECIALISTS 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:
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:
1982895744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18400 KATY FWY
Provider Second Line Business Mailing Address:
SUITE 270
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77094-1286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-464-7040
Provider Business Mailing Address Fax Number:
713-464-7078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18400 KATY FWY
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77094-1286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-464-7040
Provider Business Practice Location Address Fax Number:
713-464-7078
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAIG
Authorized Official First Name:
MIRZA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER/PRES
Authorized Official Telephone Number:
713-464-7040

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  H9598 , 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: 156512901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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