Basic Information
| Provider Information | |||||||||
| NPI: | 1225280290 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER | ||||||||
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| OtherOrganizationName: | TEXAS A&M PHYSICIANS - HOUSTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 164 JOE H REYNOLDS MEDICAL BLDG | ||||||||
| Address2: | 1114 TAMU COM | ||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778431114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797768440 | ||||||||
| FaxNumber: | 9797766905 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 W HOLCOMBE BLVD | ||||||||
| Address2: | SUITE 1111 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136778100 | ||||||||
| FaxNumber: | 7136778212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 07/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9798624465 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207RR0500X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.