Provider Demographics
NPI:1629029244
Name:GO-FAITH MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:GO-FAITH MEDICAL SERVICES, INC
Other - Org Name:FAITH MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:O
Authorized Official - Last Name:IVBIEVBIOKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-774-9003
Mailing Address - Street 1:12315 W BELLFORT ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1312
Mailing Address - Country:US
Mailing Address - Phone:713-774-9003
Mailing Address - Fax:713-774-9000
Practice Address - Street 1:12315 W BELLFORT ST
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-1312
Practice Address - Country:US
Practice Address - Phone:713-774-9003
Practice Address - Fax:713-774-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010596251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
673163OtherMEDICARE PTAN
TX673163Medicare ID - Type UnspecifiedPROVIDER NUMBER