Provider Demographics
NPI:1346895828
Name:INNOVISTA MEDICAL CENTER OF TEXAS PA
Entity Type:Organization
Organization Name:INNOVISTA MEDICAL CENTER OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-590-3862
Mailing Address - Street 1:12586 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12302 JONES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4802
Practice Address - Country:US
Practice Address - Phone:305-470-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVISTA MEDICAL CENTER OF TEXAS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-01
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty