Provider Demographics
NPI:1740997592
Name:HOUSTON PHYSICIANS IPA PLLC
Entity type:Organization
Organization Name:HOUSTON PHYSICIANS IPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAN
Authorized Official - Middle Name:NHU BICH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:818-399-8996
Mailing Address - Street 1:6 VERANDA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1632
Mailing Address - Country:US
Mailing Address - Phone:818-399-8996
Mailing Address - Fax:
Practice Address - Street 1:6 VERANDA
Practice Address - Street 2:
Practice Address - City:NEWPORT COAST
Practice Address - State:CA
Practice Address - Zip Code:92657-1632
Practice Address - Country:US
Practice Address - Phone:818-399-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1143333600002OtherTEXAS SECRETARY OF STATE CERTIFICATE OF FORMATION OF PLLC