Provider Demographics
NPI: | 1760773493 |
---|---|
Name: | TMH PHYSICIAN ORGANIZATION |
Entity Type: | Organization |
Organization Name: | TMH PHYSICIAN ORGANIZATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MD |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DIRK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SOSTMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 713-441-7963 |
Mailing Address - Street 1: | 2950 CULLEN BLVD |
Mailing Address - Street 2: | SUITE 101 |
Mailing Address - City: | PEARLAND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77584-3921 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2950 CULLEN BLVD |
Practice Address - Street 2: | SUITE 101 |
Practice Address - City: | PEARLAND |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77584-3921 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-441-7963 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-04-28 |
Last Update Date: | 2011-08-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 103TC0700X, 207Q00000X, 207R00000X, 207RC0000X, 207V00000X, 207W00000X, 207X00000X, 208100000X, 208200000X, 2084P0800X, 2085R0001X, 208800000X, 208M00000X, 363A00000X, 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | TXB131136 | Medicare PIN |