Provider Demographics
NPI:1508981200
Name:RHEUMATIC DISEASE CLINIC OF HOUSTON
Entity Type:Organization
Organization Name:RHEUMATIC DISEASE CLINIC OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-341-5939
Mailing Address - Street 1:4825 ALMEDA RD.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004
Mailing Address - Country:US
Mailing Address - Phone:713-521-7865
Mailing Address - Fax:713-521-7856
Practice Address - Street 1:4825 ALMEDA RD.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-521-7865
Practice Address - Fax:713-521-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9937174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128203001Medicaid
TX00010RMedicare PIN
TX4436820001Medicare NSC