Provider Demographics
NPI:1538157326
Name:INTRACARE HOSPITAL
Entity type:Organization
Organization Name:INTRACARE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO HEALTHCARE OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOVILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-799-0100
Mailing Address - Street 1:7601 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1905
Mailing Address - Country:US
Mailing Address - Phone:713-790-0949
Mailing Address - Fax:713-799-0365
Practice Address - Street 1:7601 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1905
Practice Address - Country:US
Practice Address - Phone:713-790-0949
Practice Address - Fax:713-799-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX762283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454089Medicare ID - Type Unspecified