Provider Demographics
NPI:1053463596
Name:BASALDUA & HELLER FAMILY PRACTICE
Entity Type:Organization
Organization Name:BASALDUA & HELLER FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-465-0500
Mailing Address - Street 1:22999 HIGHWAY 59 N
Mailing Address - Street 2:SUITE 272
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22999 HIGHWAY 59 N
Practice Address - Street 2:SUITE 272
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77339-4412
Practice Address - Country:US
Practice Address - Phone:281-465-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCS5853Medicare PIN
TX00404RMedicare PIN