Basic Information
| Provider Information | |||||||||
| NPI: | 1013234574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FM2920 SPRING MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6225 FM 2920 RD | ||||||||
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| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773793474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812570404 | ||||||||
| FaxNumber: | 2812570447 | ||||||||
| Practice Location | |||||||||
| Address1: | 6225 FM 2920 RD | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773793474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812570404 | ||||||||
| FaxNumber: | 2812570447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2010 | ||||||||
| LastUpdateDate: | 04/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | MOPARTY | ||||||||
| AuthorizedOfficialFirstName: | DAYAKAR | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2812570404 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.S | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 305R00000X | Y | Managed Care Organizations | Preferred Provider Organization |
No ID Information.