Basic Information
Provider Information | |||||||||
NPI: | 1831338490 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CHAMBERS COUNTY PUBLIC HOSPITAL DISTRICT NO 1 | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | OMNI POINT HEALTH PRIMARY CARE MONT BELVIEU | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 398 | ||||||||
Address2: |   | ||||||||
City: | ANAHUAC | ||||||||
State: | TX | ||||||||
PostalCode: | 775140398 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2815760670 | ||||||||
FaxNumber: | 2815760673 | ||||||||
Practice Location | |||||||||
Address1: | 9825 EAGLE DR | ||||||||
Address2: |   | ||||||||
City: | BAYTOWN | ||||||||
State: | TX | ||||||||
PostalCode: | 775239847 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2815760670 | ||||||||
FaxNumber: | 2815760673 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/05/2009 | ||||||||
LastUpdateDate: | 05/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | STRICKLAND | ||||||||
AuthorizedOfficialFirstName: | BRITNEY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | HIM DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 4092673143 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RHIT, CMC | ||||||||
NPICertificationDate: | 05/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
ID | Type | State | Issuer | Description | 192363301 | 05 | TX |   | MEDICAID |