Provider Demographics
NPI:1679722425
Name:S.G. GHIDE, M.D,, P.A.
Entity Type:Organization
Organization Name:S.G. GHIDE, M.D,, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIESNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-851-6431
Mailing Address - Street 1:PO BOX 9840
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-6840
Mailing Address - Country:US
Mailing Address - Phone:281-732-5952
Mailing Address - Fax:281-377-4733
Practice Address - Street 1:1120 MEDICAL PLAZA DR
Practice Address - Street 2:STE 310
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3242
Practice Address - Country:US
Practice Address - Phone:281-732-5952
Practice Address - Fax:281-377-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9282207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB165608Medicare PIN
TX103664208Medicaid
TXH23435Medicare PIN