Provider Demographics
NPI:1093802571
Name:MEDICAL CENTER INTENSIVISTS, P.A.
Entity Type:Organization
Organization Name:MEDICAL CENTER INTENSIVISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-752-5994
Mailing Address - Street 1:3310 LOUVRE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-6686
Mailing Address - Country:US
Mailing Address - Phone:281-752-5994
Mailing Address - Fax:281-679-6780
Practice Address - Street 1:3310 LOUVRE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6686
Practice Address - Country:US
Practice Address - Phone:281-752-5994
Practice Address - Fax:281-679-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175809601Medicaid
00464ZMedicare PIN