Provider Demographics
NPI:1285684431
Name:TMH PHYSICIAN ORGANIZATION
Entity Type:Organization
Organization Name:TMH PHYSICIAN ORGANIZATION
Other - Org Name:TMHPO INSTITUTE FOR RECONSTRUCTIVE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:H.
Authorized Official - Middle Name:DIRK
Authorized Official - Last Name:SOSTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-790-2221
Mailing Address - Street 1:6565 FANNIN ST
Mailing Address - Street 2:D200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-790-2221
Mailing Address - Fax:713-790-2605
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:D200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-790-2221
Practice Address - Fax:713-790-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095MSOtherBCBS GROUP NUMBER
TX0A05085Medicare PIN
TX00190ZMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER