Provider Demographics
NPI:1760440705
Name:METROWEST
Entity Type:Organization
Organization Name:METROWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-242-3439
Mailing Address - Street 1:23023 CHELSEN BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1429
Mailing Address - Country:US
Mailing Address - Phone:281-392-9831
Mailing Address - Fax:
Practice Address - Street 1:23023 CHELSEN BRIDGE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1429
Practice Address - Country:US
Practice Address - Phone:281-392-9831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589424282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access