Provider Demographics
NPI:1477820553
Name:PICC HEALTH INSTITUTE LLC
Entity Type:Organization
Organization Name:PICC HEALTH INSTITUTE LLC
Other - Org Name:PICC HEALTH INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-534-1718
Mailing Address - Street 1:7324 SOUTHWEST FWY
Mailing Address - Street 2:STE 885
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:832-804-7825
Mailing Address - Fax:832-804-7837
Practice Address - Street 1:5302 CANAL STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011
Practice Address - Country:US
Practice Address - Phone:713-534-1718
Practice Address - Fax:713-640-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty