Provider Demographics
NPI:1598799116
Name:TMH PHYSICIAN ORGANIZATION
Entity Type:Organization
Organization Name:TMH PHYSICIAN ORGANIZATION
Other - Org Name:TMHPO ICU PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:DIRK
Authorized Official - Last Name:SOSTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-790-3530
Mailing Address - Street 1:PO BOX 4578
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4578
Mailing Address - Country:US
Mailing Address - Phone:800-655-2656
Mailing Address - Fax:412-822-7411
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-790-3530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W267Medicare ID - Type Unspecified