Provider Demographics
NPI:1376694976
Name:EMILIO B HISSE, MD, PA
Entity Type:Organization
Organization Name:EMILIO B HISSE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:B
Authorized Official - Last Name:HISSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-667-3885
Mailing Address - Street 1:5143 BEECHNUT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1422
Mailing Address - Country:US
Mailing Address - Phone:713-667-3885
Mailing Address - Fax:713-667-3845
Practice Address - Street 1:5555 WEST LOOP S
Practice Address - Street 2:SUITE 435
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2100
Practice Address - Country:US
Practice Address - Phone:713-667-3885
Practice Address - Fax:713-667-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7005208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139574101Medicaid
TX080931101Medicaid
TX139574101Medicaid