Provider Demographics
NPI:1073737847
Name:RIVER OAKS MEDICAL CENTER, L.P
Entity Type:Organization
Organization Name:RIVER OAKS MEDICAL CENTER, L.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-964-8895
Mailing Address - Street 1:4200 TWELVE OAKS
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6812
Mailing Address - Country:US
Mailing Address - Phone:713-623-2500
Mailing Address - Fax:
Practice Address - Street 1:4200 TWELVE OAKS
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6812
Practice Address - Country:US
Practice Address - Phone:713-623-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162457902Medicaid