Basic Information
| Provider Information | |||||||||
| NPI: | 1881712628 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOUSTON PULMONARY MEDICINE ASSOCIATES PA | ||||||||
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| OtherOrganizationName: | HOUSTON PULMONARY MEDICINE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11920 ASTORIA BLVD STE 320 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770896097 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11920 ASTORIA BLVD STE 320 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770896097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814849369 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 06/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | CHANDRASEKHAR | ||||||||
| AuthorizedOfficialFirstName: | KRISHNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2814849369 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 084156101 | 05 | TX | MEDICAID | CN5690 | 01 | TX | MEDICARE RAILROAD | OTHER | 00N36F | 01 | TX | BC/BS | OTHER |