Provider Demographics
NPI:1689916330
Name:HUNTSVILLE PHYSICAL MEDICINE INSTITUTE PA
Entity Type:Organization
Organization Name:HUNTSVILLE PHYSICAL MEDICINE INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISNARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:TREMOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-291-2111
Mailing Address - Street 1:901 NORMAL PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-3770
Mailing Address - Country:US
Mailing Address - Phone:936-291-2111
Mailing Address - Fax:936-291-0665
Practice Address - Street 1:901 NORMAL PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-3770
Practice Address - Country:US
Practice Address - Phone:936-291-2111
Practice Address - Fax:936-291-0665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1707207QS0010X, 332B00000X
TX363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6778720001Medicare NSC
TX285695Medicare PIN