Provider Demographics
NPI:1326032277
Name:BANNER HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:BANNER HEALTHCARE SERVICES, INC
Other - Org Name:BANNER HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OBEAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-272-9355
Mailing Address - Street 1:12808 W AIRPORT BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-6222
Mailing Address - Country:US
Mailing Address - Phone:713-272-9355
Mailing Address - Fax:713-272-9356
Practice Address - Street 1:12808 W AIRPORT BLVD STE 304
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-6222
Practice Address - Country:US
Practice Address - Phone:713-272-9533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167255201251E00000X
TX008886251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167255201Medicaid
TX453133Medicare Oscar/Certification