Basic Information
| Provider Information | |||||||||
| NPI: | 1639172778 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RENAISSANCE HOSPITALS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RENAISSANCE HOSPITAL GROVES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11527 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772931527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328861900 | ||||||||
| FaxNumber: | 2812271039 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 39TH ST | ||||||||
| Address2: | |||||||||
| City: | GROVES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776192905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4099625733 | ||||||||
| FaxNumber: | 4099635388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 06/24/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SMESNEY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8328861900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 000515 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 167224803 | 05 | TX | MEDICAID |