Provider Demographics
NPI:1447795042
Name:ICU ASSOCIATES OF WEST HOUSTON
Entity Type:Organization
Organization Name:ICU ASSOCIATES OF WEST HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MSA PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-580-1884
Mailing Address - Street 1:6000 FELDWOOD RD
Mailing Address - Street 2:LOCK BOX 741627
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12141 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2408
Practice Address - Country:US
Practice Address - Phone:281-558-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132181282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital