Provider Demographics
NPI:1780635425
Name:SPECTRUM CARE P.A.
Entity Type:Organization
Organization Name:SPECTRUM CARE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSOUR
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-242-7500
Mailing Address - Street 1:6100 RICHMOND
Mailing Address - Street 2:# 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057
Mailing Address - Country:US
Mailing Address - Phone:832-242-7500
Mailing Address - Fax:832-242-7800
Practice Address - Street 1:6100 RICHMOND
Practice Address - Street 2:# 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:832-242-7500
Practice Address - Fax:832-242-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM0801X261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG3069Medicare UPIN
TX454913Medicare Oscar/Certification