Provider Demographics
NPI:1033298401
Name:MCINTOSH, KADIAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KADIAN
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205209402Medicaid
TX205209404Medicaid
TX8Y0773OtherBCBS
TX800N57OtherBLUE CROSS BLUE SHIELD
TX205209403Medicaid
TX205209401Medicaid
TXP01070314OtherRR MEDICARE
TX8J0111Medicare PIN
TX8L12777Medicare PIN
TXP01070314OtherRR MEDICARE
TX8Y0773OtherBCBS
TXTXB144568Medicare PIN
TX205209404Medicaid