Provider Demographics
NPI:1295764496
Name:HOUSTON CANCER INSTITUTE PA
Entity type:Organization
Organization Name:HOUSTON CANCER INSTITUTE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOUROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-464-3343
Mailing Address - Street 1:1220 BLALOCK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6472
Mailing Address - Country:US
Mailing Address - Phone:713-464-3343
Mailing Address - Fax:713-464-2644
Practice Address - Street 1:1220 BLALOCK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6472
Practice Address - Country:US
Practice Address - Phone:713-464-3343
Practice Address - Fax:713-464-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5741174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094028001Medicaid
TXCH9402OtherRAILROAD MEDICARE
TXCH9402OtherRAILROAD MEDICARE