Provider Demographics
NPI:1265598734
Name:ADOM REHAB AND PHYSICAL MEDICINE
Entity type:Organization
Organization Name:ADOM REHAB AND PHYSICAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:O
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-776-0252
Mailing Address - Street 1:10600 FONDREN RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096
Mailing Address - Country:US
Mailing Address - Phone:713-776-0252
Mailing Address - Fax:713-776-0093
Practice Address - Street 1:10600 FONDREN RD
Practice Address - Street 2:#101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096
Practice Address - Country:US
Practice Address - Phone:713-776-0091
Practice Address - Fax:713-776-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6816111N00000X
TXF8454261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP08815K05Medicaid
TXP0899443N7Medicaid
TXP089942N7Medicaid
TXP0899443N7Medicaid
TX89942NMedicare PIN
TXP089942N7Medicaid
TXU60093Medicare UPIN