Provider Demographics
NPI:1952594251
Name:HOUSTON NEUROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:HOUSTON NEUROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS. DEPT.
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLETSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-777-4122
Mailing Address - Street 1:7500 BEECHNUT ST
Mailing Address - Street 2:#135
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-4335
Mailing Address - Country:US
Mailing Address - Phone:713-777-4122
Mailing Address - Fax:713-270-7533
Practice Address - Street 1:7500 BEECHNUT ST
Practice Address - Street 2:#135
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4335
Practice Address - Country:US
Practice Address - Phone:713-777-4122
Practice Address - Fax:713-270-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N879Medicare PIN