Provider Demographics
NPI:1407128655
Name:JOSE M. ORTEGA, M.D., FACS, P.A.
Entity Type:Organization
Organization Name:JOSE M. ORTEGA, M.D., FACS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-319-5319
Mailing Address - Street 1:18955 N MEMORIAL DR
Mailing Address - Street 2:STE. 480
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4271
Mailing Address - Country:US
Mailing Address - Phone:281-319-5319
Mailing Address - Fax:281-319-4424
Practice Address - Street 1:18955 N MEMORIAL DR
Practice Address - Street 2:STE. 480
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4271
Practice Address - Country:US
Practice Address - Phone:281-319-5319
Practice Address - Fax:281-319-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138990002Medicaid
TX138990002Medicaid
E10104Medicare UPIN