Provider Demographics
NPI:1396050514
Name:GREATER HOUSTON DIGESTIVE DISEASE CONSULTANTS
Entity type:Organization
Organization Name:GREATER HOUSTON DIGESTIVE DISEASE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AWASUM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-323-3162
Mailing Address - Street 1:134 VISION PARK BLVD STE 280
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3032
Mailing Address - Country:US
Mailing Address - Phone:281-205-1111
Mailing Address - Fax:281-419-2111
Practice Address - Street 1:134 VISION PARK BLVD STE 280
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3032
Practice Address - Country:US
Practice Address - Phone:281-205-1111
Practice Address - Fax:281-419-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 261QI0500X
TXM2544207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No251F00000XAgenciesHome InfusionGroup - Single Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2821480Medicaid
TX2821480-02Medicaid
TX8G1573Medicare PIN