Provider Demographics
NPI:1033178058
Name:SOUTHWEST SIDS RESEARCH INSTITUTE, INC.
Entity Type:Organization
Organization Name:SOUTHWEST SIDS RESEARCH INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-299-2814
Mailing Address - Street 1:230 PARKING WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5227
Mailing Address - Country:US
Mailing Address - Phone:979-297-2101
Mailing Address - Fax:979-297-6682
Practice Address - Street 1:230 PARKING WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5227
Practice Address - Country:US
Practice Address - Phone:979-297-2101
Practice Address - Fax:979-297-6682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093684101Medicaid