Provider Demographics
NPI:1033139498
Name:SOUTHWEST ASTHMA & ALLERGY ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHWEST ASTHMA & ALLERGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-596-8500
Mailing Address - Street 1:9494 SOUTHWEST FWY
Mailing Address - Street 2:600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1419
Mailing Address - Country:US
Mailing Address - Phone:713-596-8500
Mailing Address - Fax:713-596-8560
Practice Address - Street 1:9494 SOUTHWEST FWY STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1424
Practice Address - Country:US
Practice Address - Phone:713-596-8500
Practice Address - Fax:713-596-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1093742-02Medicaid
TX0042AUMedicare PIN