Provider Demographics
NPI:1306209739
Name:PICC HEALTH INSTITUTE LLC
Entity Type:Organization
Organization Name:PICC HEALTH INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:OPEYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOWOSUSI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:713-828-3939
Mailing Address - Street 1:6260 WESTPARK DR STE 266
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6260 WESTPARK DR STE 266
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7353
Practice Address - Country:US
Practice Address - Phone:713-828-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No341600000XTransportation ServicesAmbulance