Provider Demographics
NPI:1811997919
Name:IHS ACQUISITION NO 170 INC
Entity type:Organization
Organization Name:IHS ACQUISITION NO 170 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-539-2354
Mailing Address - Street 1:1310 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2208
Mailing Address - Country:US
Mailing Address - Phone:361-888-4323
Mailing Address - Fax:361-884-5018
Practice Address - Street 1:1310 3RD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2208
Practice Address - Country:US
Practice Address - Phone:361-888-4323
Practice Address - Fax:361-884-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000699284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
452036Medicare ID - Type Unspecified