Provider Demographics
NPI:1043431521
Name:CHARLES G HOLMSTEN MD AND ASSOCIATES
Entity Type:Organization
Organization Name:CHARLES G HOLMSTEN MD AND ASSOCIATES
Other - Org Name:BRAESWOOD AND PASADENA AND RICHMOND ROSENBERG CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND SEL PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOLMSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-777-3131
Mailing Address - Street 1:7545 S BRAESWOOD BLVD
Mailing Address - Street 2:117 LANE DR TX 77471 AND 3122 SPENCER HWY TX 77504
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-1423
Mailing Address - Country:US
Mailing Address - Phone:713-777-3131
Mailing Address - Fax:713-777-5544
Practice Address - Street 1:7545 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-1423
Practice Address - Country:US
Practice Address - Phone:713-777-3131
Practice Address - Fax:713-777-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8734207QA0505X, 261QX0100X
TXD6035207QA0505X, 261QX0100X
TXL8535207QA0505X, 261QX0100X
TXK7677207QA0505X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Not Answered261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108343OtherAMERIGROUP M E BUXBAUM,DO
TX57420HOtherBC BS GROUP NUMBER
TX8M5130OtherBC BS WALTER R HOLMSTEN
TX8F5610OtherBC BS M E BUXBAUM, DO
TX84V645OtherBC BS CHARLES G HOLMSTEN
TX25422OtherAMERIGROUP C G HOLMSTEN
TX8F5610OtherBC BS M E BUXBAUM, DO
TX108343OtherAMERIGROUP M E BUXBAUM,DO
TX57420HOtherBC BS GROUP NUMBER
TXH00609Medicare UPIN
TX25422OtherAMERIGROUP C G HOLMSTEN
TXB23561Medicare UPIN
TX00L31LMedicare ID - Type UnspecifiedGROUP NUMBER