Provider Demographics
NPI:1417958067
Name:LIVER, KIDNEY NAD INTERNAL MEDICINE CENTER
Entity Type:Organization
Organization Name:LIVER, KIDNEY NAD INTERNAL MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIPSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-635-6996
Mailing Address - Street 1:5116 BISSONNET ST
Mailing Address - Street 2:SUITE 327
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8300 HOMESTEAD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-2145
Practice Address - Country:US
Practice Address - Phone:713-635-6996
Practice Address - Fax:713-635-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8034261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00978XMedicare ID - Type Unspecified
TXY25719Medicare UPIN