Provider Demographics
NPI:1891718789
Name:VISTA COMMUNITY MEDICAL CENTER LLP
Entity Type:Organization
Organization Name:VISTA COMMUNITY MEDICAL CENTER LLP
Other - Org Name:SURGERY SPECIALTY HOSPITALS OF AMERICA SOUTHEAST HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS FINANCIAL SVC
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:N
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-378-3000
Mailing Address - Street 1:4301 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2117
Mailing Address - Country:US
Mailing Address - Phone:713-378-3000
Mailing Address - Fax:713-378-3104
Practice Address - Street 1:4301 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2117
Practice Address - Country:US
Practice Address - Phone:713-378-3000
Practice Address - Fax:713-378-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006941282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020981901Medicaid
TXHH0975OtherBCBS #
TX450831Medicare Oscar/Certification