Provider Demographics
NPI:1548894751
Name:EMERGENCY MEDICINE PHYSICIAN OF HOUSTON
Entity type:Organization
Organization Name:EMERGENCY MEDICINE PHYSICIAN OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MASVERO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:281-501-2841
Mailing Address - Street 1:4000 WASHINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5676
Mailing Address - Country:US
Mailing Address - Phone:281-501-2841
Mailing Address - Fax:281-715-2122
Practice Address - Street 1:4000 WASHINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5676
Practice Address - Country:US
Practice Address - Phone:281-501-2841
Practice Address - Fax:281-715-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty