Provider Demographics
NPI:1619183951
Name:POVILAS VITENAS JR MD
Entity Type:Organization
Organization Name:POVILAS VITENAS JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:POVILAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VITENAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-484-0088
Mailing Address - Street 1:11914 ASTORIA BLVD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6064
Mailing Address - Country:US
Mailing Address - Phone:281-484-0088
Mailing Address - Fax:
Practice Address - Street 1:11914 ASTORIA BLVD
Practice Address - Street 2:SUITE 470
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6064
Practice Address - Country:US
Practice Address - Phone:281-484-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
612884Medicare PIN
TXB89680Medicare UPIN