Provider Demographics
NPI:1083655856
Name:MEDICAL CENTER FOR IMMUNE & TOXIC DISORDERS, LTD., L.L.P.
Entity type:Organization
Organization Name:MEDICAL CENTER FOR IMMUNE & TOXIC DISORDERS, LTD., L.L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:IMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:281-681-8989
Mailing Address - Street 1:25010 OAKHURST DR
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2719
Mailing Address - Country:US
Mailing Address - Phone:281-681-8989
Mailing Address - Fax:281-664-5521
Practice Address - Street 1:25010 OAKHURST DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2719
Practice Address - Country:US
Practice Address - Phone:281-681-8989
Practice Address - Fax:281-664-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X, 204D00000X, 207KI0005X, 207Q00000X, 207RI0001X, 2084N0400X, 2083T0002X, 2080T0002X, 2084N0600X, 207R00000X, 209800000X, 103TF0200X, 2472E0500X, 2471C3402X, 225B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function TechnologistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory ImmunologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical ToxicologyGroup - Multi-Specialty
No2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical ToxicologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Multi-Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER