Provider Demographics
NPI:1861546525
Name:HOUSTON PSC, LP
Entity type:Organization
Organization Name:HOUSTON PSC, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:7515 MAIN ST
Mailing Address - Street 2:STE 800
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4519
Mailing Address - Country:US
Mailing Address - Phone:713-799-9990
Mailing Address - Fax:713-796-1142
Practice Address - Street 1:7515 MAIN ST
Practice Address - Street 2:STE 800
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4519
Practice Address - Country:US
Practice Address - Phone:713-799-9990
Practice Address - Fax:713-796-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000364261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC078Medicare PIN
TX45C0001035Medicare Oscar/Certification