Provider Demographics
NPI:1780896480
Name:PROTEA HEALTH INC
Entity type:Organization
Organization Name:PROTEA HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PILISZEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-469-4156
Mailing Address - Street 1:17200 STATE HIGHWAY 249
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1184
Mailing Address - Country:US
Mailing Address - Phone:281-469-4156
Mailing Address - Fax:281-469-7315
Practice Address - Street 1:17200 STATE HIGHWAY 249
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1184
Practice Address - Country:US
Practice Address - Phone:281-469-4156
Practice Address - Fax:281-469-7315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1149261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB25512Medicare UPIN
TX00EU06Medicare ID - Type Unspecified