Provider Demographics
NPI:1124011465
Name:MEDICAL CENTER EAR, NOSE AND THROAT ASSOCIATES OF HOUSTON, PLLC
Entity Type:Organization
Organization Name:MEDICAL CENTER EAR, NOSE AND THROAT ASSOCIATES OF HOUSTON, PLLC
Other - Org Name:HOUSTON SINUS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:BLACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MHA, CMPE
Authorized Official - Phone:713-795-0111
Mailing Address - Street 1:4101 GREENBRIAR ST.
Mailing Address - Street 2:SUITE #320
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-5296
Mailing Address - Country:US
Mailing Address - Phone:713-795-0111
Mailing Address - Fax:713-795-8586
Practice Address - Street 1:4101 GREENBRIAR ST.
Practice Address - Street 2:SUITE #320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-5296
Practice Address - Country:US
Practice Address - Phone:713-795-0111
Practice Address - Fax:713-490-5987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0844375-01Medicaid