Provider Demographics
NPI:1033214093
Name:JOHN C. HAIRSTON, M.D., P.A.
Entity Type:Organization
Organization Name:JOHN C. HAIRSTON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-313-7878
Mailing Address - Street 1:16659 SOUTHWEST FWY
Mailing Address - Street 2:MEDICAL OFFICE BLDG II, STE 225
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2375
Mailing Address - Country:US
Mailing Address - Phone:281-313-7878
Mailing Address - Fax:281-313-7880
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:MEDICAL OFFICE BLDG II, STE 225
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-313-7878
Practice Address - Fax:281-313-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4417208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4248755OtherBLUE LINK
TXDF7297OtherMEDICARE RAIL ROAD
TX5472630OtherCIGNA
TX186303701Medicaid
TX0035NXOtherBLUE CROSS BLUE SHIELD
TX5472630OtherCIGNA