Provider Demographics
NPI:1346406725
Name:SOUTHWEST ASTHMA & ALLERGY ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHWEST ASTHMA & ALLERGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-596-8500
Mailing Address - Street 1:12606 W HOUSTON CENTER BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2790
Mailing Address - Country:US
Mailing Address - Phone:713-596-8526
Mailing Address - Fax:713-596-8560
Practice Address - Street 1:1140 CLEAR LAKE CITY BLVD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-8128
Practice Address - Country:US
Practice Address - Phone:281-461-3300
Practice Address - Fax:281-461-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1093742-01Medicaid
TX10593624OtherCAQH