Provider Demographics
NPI:1114303427
Name:TEXANS MULTISPECIALTY MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:TEXANS MULTISPECIALTY MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEODULO
Authorized Official - Middle Name:E
Authorized Official - Last Name:AVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-321-8627
Mailing Address - Street 1:9525 KATY FWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1407
Mailing Address - Country:US
Mailing Address - Phone:713-863-7246
Mailing Address - Fax:888-371-2259
Practice Address - Street 1:9525 KATY FWY
Practice Address - Street 2:SUITE 130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1407
Practice Address - Country:US
Practice Address - Phone:713-863-7246
Practice Address - Fax:888-371-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty