Provider Demographics
NPI:1659324093
Name:M D ANDERSON PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:M D ANDERSON PHYSICIANS NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:HYSLOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-745-9610
Mailing Address - Street 1:PO BOX 201790
Mailing Address - Street 2:M D ANDERSON PHYSICIANS NETWORK CO JP MORGAN CHASE BANK
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1790
Mailing Address - Country:US
Mailing Address - Phone:713-745-9700
Mailing Address - Fax:713-792-2106
Practice Address - Street 1:6602 MAPLERIDGE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081
Practice Address - Country:US
Practice Address - Phone:713-745-6123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084813701Medicaid
TX084813701Medicaid