Provider Demographics
NPI:1598279580
Name:PHYSICIAN ACUTE CARE SERVICES KINGWOOD, PLLC
Entity Type:Organization
Organization Name:PHYSICIAN ACUTE CARE SERVICES KINGWOOD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-653-3200
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:NEW WAVERLY
Mailing Address - State:TX
Mailing Address - Zip Code:77358-0190
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:713-808-9176
Practice Address - Street 1:23330 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4471
Practice Address - Country:US
Practice Address - Phone:832-653-3200
Practice Address - Fax:832-653-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZGPPOXOtherBLUE CROSS BLUE SHIELD