Provider Demographics
NPI:1437428349
Name:KIRKWOOD MEDICAL SERVICE INC
Entity Type:Organization
Organization Name:KIRKWOOD MEDICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BANG
Authorized Official - Middle Name:BA
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-777-1508
Mailing Address - Street 1:9100 SOUTHWEST FWY STE 215
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1513
Mailing Address - Country:US
Mailing Address - Phone:713-777-1508
Mailing Address - Fax:713-777-1509
Practice Address - Street 1:9100 SOUTHWEST FWY
Practice Address - Street 2:215
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1519
Practice Address - Country:US
Practice Address - Phone:713-777-1508
Practice Address - Fax:713-777-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 208D00000X
TXF1361261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB149317Medicare PIN