Provider Demographics
NPI:1043533193
Name:PREMIER INFECTIOUS DISEASE ASSOCIATES PA
Entity Type:Organization
Organization Name:PREMIER INFECTIOUS DISEASE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMASHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-587-8777
Mailing Address - Street 1:PO BOX 11230
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-1230
Mailing Address - Country:US
Mailing Address - Phone:281-587-8777
Mailing Address - Fax:281-587-2577
Practice Address - Street 1:800 PEAKWOOD DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2900
Practice Address - Country:US
Practice Address - Phone:281-587-8777
Practice Address - Fax:281-587-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6398207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty