Provider Demographics
NPI:1356646657
Name:MOMENTUMPHP CORP
Entity Type:Organization
Organization Name:MOMENTUMPHP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:III
Authorized Official - Credentials:MR
Authorized Official - Phone:713-858-9501
Mailing Address - Street 1:3448 WICHITA ST.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004
Mailing Address - Country:US
Mailing Address - Phone:713-858-9501
Mailing Address - Fax:
Practice Address - Street 1:3448 WICHITA STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-858-9501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service