Provider Demographics
NPI:1679653125
Name:ST. JOSEPH DERMATOPATHOLOGY, P.A.
Entity Type:Organization
Organization Name:ST. JOSEPH DERMATOPATHOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:TSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-660-9444
Mailing Address - Street 1:6909 GREENBRIAR ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3205
Mailing Address - Country:US
Mailing Address - Phone:713-660-9444
Mailing Address - Fax:713-660-9466
Practice Address - Street 1:6909 GREENBRIAR ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3205
Practice Address - Country:US
Practice Address - Phone:713-660-9444
Practice Address - Fax:713-660-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8980207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0858722OtherCLIA
TX164670501Medicaid
TX00000055LCOtherBCBS
TX0000CL8261OtherBCBS
TXP00061050OtherRR MEDICARE
TX45D0858722OtherCLIA