Provider Demographics
NPI:1407552102
Name:HOUSTON PHYSICIAN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:HOUSTON PHYSICIAN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WHILDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-542-7959
Mailing Address - Street 1:1601 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3431
Mailing Address - Country:US
Mailing Address - Phone:478-923-0144
Mailing Address - Fax:
Practice Address - Street 1:1701 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3633
Practice Address - Country:US
Practice Address - Phone:478-923-0144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON PHYSICIAN SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty