Provider Demographics
NPI:1629251137
Name:SHANE G LANYS MD PA
Entity Type:Organization
Organization Name:SHANE G LANYS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:N
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-721-4114
Mailing Address - Street 1:7739 W BELLFORT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2104
Mailing Address - Country:US
Mailing Address - Phone:713-721-4114
Mailing Address - Fax:713-721-2349
Practice Address - Street 1:7739 W BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2104
Practice Address - Country:US
Practice Address - Phone:713-721-4114
Practice Address - Fax:713-721-2349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8597B9TOtherMEDICARE
TX86202ZOtherRENAISSANCE
TX8597B9OtherMEDICARE
TX1467412759OtherOLD NPI NUMBER
TX0034HLOtherBLUE CROSS
TX00140UMedicare PIN
TX1467412759OtherOLD NPI NUMBER
TX8597B9OtherMEDICARE