Provider Demographics
NPI:1629524376
Name:NUPHYSICIA HEALTH OF TEXAS
Entity Type:Organization
Organization Name:NUPHYSICIA HEALTH OF TEXAS
Other - Org Name:NHOT
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BOULTINGHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-358-9271
Mailing Address - Street 1:4625 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 142
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:713-358-9271
Mailing Address - Fax:713-358-9269
Practice Address - Street 1:4625 SOUTHWEST FWY
Practice Address - Street 2:SUITE 142
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7100
Practice Address - Country:US
Practice Address - Phone:713-358-9271
Practice Address - Fax:713-358-9269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2256172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG2256OtherMEDICAL LISCENSE