Provider Demographics
NPI:1760462709
Name:PROTON THERAPY CENTER-HOUSTON LTD
Entity Type:Organization
Organization Name:PROTON THERAPY CENTER-HOUSTON LTD
Other - Org Name:THE UNIVERSITY OF TEXAS M.D. ANDERSON CANCER CENTER PROTON THERAPY CEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:STYLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:713-563-9319
Mailing Address - Street 1:1840 OLD SPANISH TRAIL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2002
Mailing Address - Country:US
Mailing Address - Phone:713-563-3617
Mailing Address - Fax:713-563-1521
Practice Address - Street 1:1840 OLD SPANISH TRAIL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2002
Practice Address - Country:US
Practice Address - Phone:713-563-3617
Practice Address - Fax:713-563-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR29060261QX0203X
261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177371501Medicaid
TX177371501Medicaid
00504ZMedicare PIN