Provider Demographics
NPI:1700275666
Name:INNOVA ANESTHESIA PLLC
Entity Type:Organization
Organization Name:INNOVA ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASEM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-580-9030
Mailing Address - Street 1:PO BOX 73265
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3265
Mailing Address - Country:US
Mailing Address - Phone:281-580-9030
Mailing Address - Fax:281-580-2725
Practice Address - Street 1:11920 ASTORIA BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6097
Practice Address - Country:US
Practice Address - Phone:281-580-9030
Practice Address - Fax:281-580-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4132207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID