Provider Demographics
NPI:1326558594
Name:WEST HOUSTON AESTHETIC AND PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:WEST HOUSTON AESTHETIC AND PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:EWING
Authorized Official - Last Name:VER HALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPAS, PA-C
Authorized Official - Phone:713-818-5367
Mailing Address - Street 1:PO BOX 1242
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-1242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 WISTERIA WAY
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262-9083
Practice Address - Country:US
Practice Address - Phone:713-818-5367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty