Provider Demographics
NPI:1215236351
Name:BASILEIA GROUP, INC
Entity type:Organization
Organization Name:BASILEIA GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:713-263-7680
Mailing Address - Street 1:1102 PINEMONT DR STE F
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-1323
Mailing Address - Country:US
Mailing Address - Phone:713-263-7680
Mailing Address - Fax:713-263-7685
Practice Address - Street 1:1102 PINEMONT DR STE F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-1323
Practice Address - Country:US
Practice Address - Phone:713-263-7680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BASILEIA GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-15
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25684332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148375Medicaid