Provider Demographics
NPI:1891741468
Name:DOCTORS HOSPITAL 1997 LP
Entity Type:Organization
Organization Name:DOCTORS HOSPITAL 1997 LP
Other - Org Name:UNITED MEMORIAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FARIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-618-8505
Mailing Address - Street 1:PO BOX 4346
Mailing Address - Street 2:DEPT 198
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:281-618-8500
Mailing Address - Fax:281-618-8636
Practice Address - Street 1:510 W. TIDWELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-4339
Practice Address - Country:US
Practice Address - Phone:281-618-8500
Practice Address - Fax:281-618-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X, 261Q00000X
TX282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112727603Medicaid
TX112727603Medicaid