Provider Demographics
NPI:1932104965
Name:PASADENA HEALTH CENTER, INC
Entity Type:Organization
Organization Name:PASADENA HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SWEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-554-1091
Mailing Address - Street 1:908 SOUTHMORE AVE.
Mailing Address - Street 2:STE 100
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-1120
Mailing Address - Country:US
Mailing Address - Phone:713-554-1091
Mailing Address - Fax:713-554-1096
Practice Address - Street 1:908 SOUTHMORE AVE
Practice Address - Street 2:STE 100
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1134
Practice Address - Country:US
Practice Address - Phone:713-554-1091
Practice Address - Fax:713-554-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8570261QF0400X
TXM8383261QF0400X
TX21495261QF0400X
TX19719261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177817701Medicaid
TX671843Medicare Oscar/Certification
TX671843Medicare PIN