Provider Demographics
NPI:1215391941
Name:1960 PHYSICIAN ASSOCIATES
Entity Type:Organization
Organization Name:1960 PHYSICIAN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SYDENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-703-9060
Mailing Address - Street 1:837 CYPRESS CREEK PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3422
Mailing Address - Country:US
Mailing Address - Phone:281-586-3888
Mailing Address - Fax:281-440-2020
Practice Address - Street 1:837 CYPRESS CREEK PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3423
Practice Address - Country:US
Practice Address - Phone:281-453-2585
Practice Address - Fax:281-440-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty