Basic Information
| Provider Information | |||||||||
| NPI: | 1417032343 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHAMBERS COUNTY PUBLIC HOSPITAL DISTRICT NO 1 | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | OMNI POINT HEALTH PRIMARY CARE ANAHUAC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 398 | ||||||||
| Address2: | |||||||||
| City: | ANAHUAC | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775140398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4092674126 | ||||||||
| FaxNumber: | 4092674120 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 S ROSS STERLING | ||||||||
| Address2: | |||||||||
| City: | ANAHUAC | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4092674126 | ||||||||
| FaxNumber: | 4092674120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 05/13/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ASLIN | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4092672950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | FACHE | ||||||||
| NPICertificationDate: | 05/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 0005356055 | 01 | TX | AETNA NON HMO | OTHER | 0002556037 | 01 | TX | AETNA HMO | OTHER | 127254402 | 05 | TX | MEDICAID | 127254404 | 05 | TX | MEDICAID | 00R17Z | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 127254406 | 05 | TX | MEDICAID |