Basic Information
| Provider Information | |||||||||
| NPI: | 1114995206 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL CENTER REHABILITATION PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 200903 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772160903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137975991 | ||||||||
| FaxNumber: | 7137975904 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 MOURSUND ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137975991 | ||||||||
| FaxNumber: | 7137975904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 08/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | FRANCISCO | ||||||||
| AuthorizedOfficialFirstName: | GERARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 7137975991 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 081192901 | 05 | TX | MEDICAID |