Provider Demographics
NPI:1417401258
Name:UT PHYSICIANS
Entity Type:Organization
Organization Name:UT PHYSICIANS
Other - Org Name:UT PHYSICIANS COMMUNITY HEALTH & WELLNESS CENTER -SOUTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FAHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA,MS, CLSSGB
Authorized Official - Phone:713-486-5915
Mailing Address - Street 1:10623 BELLAIRE BLVD
Mailing Address - Street 2:SUITE C280
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5242
Mailing Address - Country:US
Mailing Address - Phone:713-486-5900
Mailing Address - Fax:713-486-5901
Practice Address - Street 1:10623 BELLAIRE BLVD
Practice Address - Street 2:SUITE C280
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5242
Practice Address - Country:US
Practice Address - Phone:713-486-5900
Practice Address - Fax:713-486-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073811832Medicaid
TX1457775058Medicaid
TX1194919027Medicaid
TX1225299753Medicaid
TX1407248149Medicaid