Provider Demographics
NPI:1346363686
Name:MT HOUSTON URGENT CARE
Entity type:Organization
Organization Name:MT HOUSTON URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHIRAH
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:281-646-1935
Mailing Address - Street 1:11753 W BELLFORT ST
Mailing Address - Street 2:STE 100
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1327
Mailing Address - Country:US
Mailing Address - Phone:281-495-1178
Mailing Address - Fax:281-646-0927
Practice Address - Street 1:11753 W BELLFORT ST
Practice Address - Street 2:STE 100
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-1327
Practice Address - Country:US
Practice Address - Phone:281-495-1178
Practice Address - Fax:281-646-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9083146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0052LXOtherBCBS GROUP ID
TX00244XMedicare PIN