Provider Demographics
NPI:1104040641
Name:NORTH HOUSTON DIAGNOSTIC CTR PA
Entity Type:Organization
Organization Name:NORTH HOUSTON DIAGNOSTIC CTR PA
Other - Org Name:AIRLINE PHYSICAL THERAPY AND REHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KOKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-699-6202
Mailing Address - Street 1:PO BOX 11940
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77293-1940
Mailing Address - Country:US
Mailing Address - Phone:713-694-0357
Mailing Address - Fax:713-699-6218
Practice Address - Street 1:5990 AIRLINE DR
Practice Address - Street 2:#290
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4233
Practice Address - Country:US
Practice Address - Phone:713-694-0357
Practice Address - Fax:713-699-6218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8130111N00000X
TXG12582081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMDG1258OtherDR CHANA WC AND COMM
TXMDG1258OtherDR CHANA WC AND COMM