Provider Demographics
NPI:1679180293
Name:TEXAS INDUSTRIAL MEDICAL
Entity Type:Organization
Organization Name:TEXAS INDUSTRIAL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:SCHAFER
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-941-4174
Mailing Address - Street 1:1009 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-5327
Mailing Address - Country:US
Mailing Address - Phone:819-414-1742
Mailing Address - Fax:281-941-4692
Practice Address - Street 1:1009 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-5327
Practice Address - Country:US
Practice Address - Phone:819-414-1742
Practice Address - Fax:281-941-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine