Provider Demographics
NPI:1689671596
Name:NORTHWEST HOUSTON NEUROLOGY, PA
Entity Type:Organization
Organization Name:NORTHWEST HOUSTON NEUROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:SANTAMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-357-5678
Mailing Address - Street 1:455 SCHOOL ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4593
Mailing Address - Country:US
Mailing Address - Phone:281-357-5678
Mailing Address - Fax:281-357-8765
Practice Address - Street 1:455 SCHOOL ST
Practice Address - Street 2:SUITE 20
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4593
Practice Address - Country:US
Practice Address - Phone:281-357-5678
Practice Address - Fax:281-357-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0040KGOtherBLUE CROSS & BLUE SHIELD
TX162810901Medicaid
TX00627VMedicare ID - Type Unspecified