Provider Demographics
NPI:1114251634
Name:VINTAGE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:VINTAGE HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:OWUAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-739-3825
Mailing Address - Street 1:8700 COMMERCE PARK DR
Mailing Address - Street 2:228D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7497
Mailing Address - Country:US
Mailing Address - Phone:281-739-3825
Mailing Address - Fax:
Practice Address - Street 1:8700 COMMERCE PARK DR
Practice Address - Street 2:228D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7497
Practice Address - Country:US
Practice Address - Phone:281-739-3825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 207Q00000X, 208D00000X
TX10004623416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Multi-Specialty