Provider Demographics
NPI:1770763815
Name:LONGPOINT MEDICAL PA
Entity type:Organization
Organization Name:LONGPOINT MEDICAL PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDUR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-893-6214
Mailing Address - Street 1:9504 LONG POINT RD STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-4226
Mailing Address - Country:US
Mailing Address - Phone:713-461-3535
Mailing Address - Fax:713-461-3518
Practice Address - Street 1:9504 LONG POINT RD STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4226
Practice Address - Country:US
Practice Address - Phone:713-893-6214
Practice Address - Fax:713-461-3518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2584261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080572302Medicaid
TX00173ZMedicare PIN
TXH48561Medicare UPIN