Provider Demographics
NPI:1558085431
Name:IHN MEDICAL PA
Entity Type:Organization
Organization Name:IHN MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENCHION
Authorized Official - Middle Name:
Authorized Official - Last Name:STONUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-337-3656
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-0907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5018 CASA GRANDE ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-7505
Practice Address - Country:US
Practice Address - Phone:281-337-3656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty