Provider Demographics
NPI:1669894218
Name:UGHS BAYTOWN PHYSICIAN SERVICES INC.
Entity type:Organization
Organization Name:UGHS BAYTOWN PHYSICIAN SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:JIWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-724-7466
Mailing Address - Street 1:2718A N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-3909
Mailing Address - Country:US
Mailing Address - Phone:936-336-3616
Mailing Address - Fax:936-336-3605
Practice Address - Street 1:2718A N MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3909
Practice Address - Country:US
Practice Address - Phone:936-336-3616
Practice Address - Fax:936-336-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care