Provider Demographics
NPI:1891067203
Name:BLUEBONNET HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:BLUEBONNET HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-417-2094
Mailing Address - Street 1:668 BUNKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-5119
Mailing Address - Country:US
Mailing Address - Phone:713-416-2421
Mailing Address - Fax:281-616-6454
Practice Address - Street 1:4001 W SAM HOUSTON PKWY N
Practice Address - Street 2:STE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-1235
Practice Address - Country:US
Practice Address - Phone:713-417-2094
Practice Address - Fax:832-204-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000261QR0200X
261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology