Provider Demographics
NPI:1740309004
Name:MEDICAL CENTER NEONATAL ASSOC PA
Entity type:Organization
Organization Name:MEDICAL CENTER NEONATAL ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BESMA
Authorized Official - Middle Name:I
Authorized Official - Last Name:ADHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-796-0003
Mailing Address - Street 1:PO BOX 270898
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77277
Mailing Address - Country:US
Mailing Address - Phone:713-796-0003
Mailing Address - Fax:713-796-0005
Practice Address - Street 1:5615 KIRBY
Practice Address - Street 2:#440
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005
Practice Address - Country:US
Practice Address - Phone:713-796-0003
Practice Address - Fax:713-796-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085387101Medicaid
TX00U97QOtherBCBS