Provider Demographics
NPI:1841588431
Name:COMMUNITY MEDICAL AND MENTAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL AND MENTAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHEDRIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-541-0810
Mailing Address - Street 1:4846 LAZY TIMBERS DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4455
Mailing Address - Country:US
Mailing Address - Phone:713-541-0810
Mailing Address - Fax:866-924-6348
Practice Address - Street 1:4846 LAZY TIMBERS DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4455
Practice Address - Country:US
Practice Address - Phone:713-541-0810
Practice Address - Fax:866-924-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB120337Medicare Oscar/Certification