Basic Information
| Provider Information | |||||||||
| NPI: | 1285699835 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WEBSTER SURGICAL SPECIALTY HOSPITAL, LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOUSTON PHYSICIANS' HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4396 | ||||||||
| Address2: | DEPT 496 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772104396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815575620 | ||||||||
| FaxNumber: | 2813351708 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N TEXAS AVE | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815575620 | ||||||||
| FaxNumber: | 2813351708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | CRAFTS | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2815575621 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 008220 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HH1082 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |