Provider Demographics
NPI:1225280290
Name:TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
Entity Type:Organization
Organization Name:TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
Other - Org Name:TEXAS A&M PHYSICIANS - HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:979-862-4465
Mailing Address - Street 1:164 JOE H REYNOLDS MEDICAL BLDG
Mailing Address - Street 2:1114 TAMU COM
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-1114
Mailing Address - Country:US
Mailing Address - Phone:979-776-8440
Mailing Address - Fax:979-776-6905
Practice Address - Street 1:2121 W HOLCOMBE BLVD
Practice Address - Street 2:SUITE 1111
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3303
Practice Address - Country:US
Practice Address - Phone:713-677-8100
Practice Address - Fax:713-677-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty