Basic Information
| Provider Information | |||||||||
| NPI: | 1124200860 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEEPLECHASE DIAGNOSTIC CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20366 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772250366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819801330 | ||||||||
| FaxNumber: | 2819801331 | ||||||||
| Practice Location | |||||||||
| Address1: | 2616 S LOOP W | ||||||||
| Address2: | STE 170-B | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667572687 | ||||||||
| FaxNumber: | 2819801331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 12/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | KOKO | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2819801330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | J5877 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | J5877 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.