Provider Demographics
NPI:1700802303
Name:GREATER HOUSTON UROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:GREATER HOUSTON UROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-522-1944
Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:#1340
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-522-1944
Mailing Address - Fax:
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:#1340
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-522-1944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6951208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1027706OtherAETNA
TX000000R478OtherBLUE CROSS BLUE SHIELD
TX0847949-01Medicaid
TXCS9136OtherRAILROAD MEDICARE
TX00R478Medicare ID - Type Unspecified