Provider Demographics
NPI:1528366614
Name:RED BIRD CENTER
Entity Type:Organization
Organization Name:RED BIRD CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJORIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOSOY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, PC
Authorized Official - Phone:713-621-2700
Mailing Address - Street 1:6300 WEST LOOP S
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2900
Mailing Address - Country:US
Mailing Address - Phone:713-621-2700
Mailing Address - Fax:
Practice Address - Street 1:6300 WEST LOOP S
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2900
Practice Address - Country:US
Practice Address - Phone:713-621-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22131251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
00X296Medicare PIN