Provider Demographics
NPI:1689815359
Name:CELESTIAL SPECIALTY CARE, PA
Entity Type:Organization
Organization Name:CELESTIAL SPECIALTY CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-664-2662
Mailing Address - Street 1:PO BOX 741126
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-1126
Mailing Address - Country:US
Mailing Address - Phone:713-532-7311
Mailing Address - Fax:731-532-7399
Practice Address - Street 1:5420 WEST LOOP S STE 3500
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2121
Practice Address - Country:US
Practice Address - Phone:713-664-2662
Practice Address - Fax:713-987-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6533261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical