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:2022-07-21
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
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Not Answered207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory ImmunologyGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical ToxicologyGroup - Multi-Specialty
Not Answered2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical ToxicologyGroup - Multi-Specialty
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Not Answered2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Multi-Specialty
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
Not Answered225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER