Provider Demographics
NPI:1811214414
Name:GREATER HOUSTON PHYSICIAN'S MEDICAL
Entity Type:Organization
Organization Name:GREATER HOUSTON PHYSICIAN'S MEDICAL
Other - Org Name:GREATER HOUSTON PHYSICIAN'S MEDICALASSOC., PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-312-8565
Mailing Address - Street 1:8850 SIX PINES DR
Mailing Address - Street 2:270
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2683
Mailing Address - Country:US
Mailing Address - Phone:281-587-8276
Mailing Address - Fax:
Practice Address - Street 1:22698 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6008
Practice Address - Country:US
Practice Address - Phone:281-359-2870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA5330Medicare PIN