Basic Information
| Provider Information | |||||||||
| NPI: | 1659851293 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CC HMS TX, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 CENTRAL EXPY S STE 400 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750138113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662250350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1604 ROCK PRAIRIE RD | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778458345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797645100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| AuthorizedOfficialLastName: | GICHERU | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2148938619 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.