Basic Information
| Provider Information | |||||||||
| NPI: | 1205028727 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEEPLECHASE DIAGNOSTIC CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2569 | ||||||||
| Address2: | |||||||||
| City: | STAFFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774972569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136641330 | ||||||||
| FaxNumber: | 7136643355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 S MASON RD | ||||||||
| Address2: | #350 | ||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774506148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667572687 | ||||||||
| FaxNumber: | 8887572680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2007 | ||||||||
| LastUpdateDate: | 07/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | RICHEY | ||||||||
| AuthorizedOfficialFirstName: | L | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7136641330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | 201483601 | 05 | TX | MEDICAID |