Basic Information
| Provider Information | |||||||||
| NPI: | 1457652588 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHCA MAINLAND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6801 EMMETT F LOWRY EXPY | ||||||||
| Address2: | |||||||||
| City: | TEXAS CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775912500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4099385000 | ||||||||
| FaxNumber: | 4099385001 | ||||||||
| Practice Location | |||||||||
| Address1: | 6807 EMMETT F LOWRY EXPY | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | TEXAS CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775912546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4099385000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2010 | ||||||||
| LastUpdateDate: | 11/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | CALLAWAY | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4099385000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Pediatrics | 163WW0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory |
No ID Information.