Provider Demographics
NPI:1245322163
Name:ROC-HOUSTON, PA
Entity type:Organization
Organization Name:ROC-HOUSTON, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:V
Authorized Official - Last Name:MASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-520-1210
Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:#100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6944
Mailing Address - Country:US
Mailing Address - Phone:713-520-1210
Mailing Address - Fax:713-400-8302
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:#100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6944
Practice Address - Country:US
Practice Address - Phone:713-520-1210
Practice Address - Fax:713-400-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165044201Medicaid
TX8M6540OtherBLUE CROSS & BLUE SHIELD
8B7570Medicare PIN
TX165044201Medicaid