Provider Demographics
NPI:1205082153
Name:HOUSTON PLASTIC AND RECONSTRUCTIVE SURGERY
Entity type:Organization
Organization Name:HOUSTON PLASTIC AND RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-282-9555
Mailing Address - Street 1:575 E MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4326
Mailing Address - Country:US
Mailing Address - Phone:281-282-9555
Mailing Address - Fax:
Practice Address - Street 1:575 E MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4326
Practice Address - Country:US
Practice Address - Phone:281-282-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003BMMedicare PIN