Provider Demographics
NPI:1326032277
Name:BANNER HEALTHCARE SERVICES, INC
Entity type:Organization
Organization Name:BANNER HEALTHCARE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OBEAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-272-9355
Mailing Address - Street 1:6538 GREATWOOD PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6312
Mailing Address - Country:US
Mailing Address - Phone:281-782-2396
Mailing Address - Fax:713-272-9356
Practice Address - Street 1:6538 GREATWOOD PKWY STE A
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6312
Practice Address - Country:US
Practice Address - Phone:713-272-9355
Practice Address - Fax:713-272-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008886251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167255201Medicaid
TX453133Medicare Oscar/Certification