Provider Demographics
NPI:1699785444
Name:KATY INTERNAL MEDICINE ASSOCIATES, L.L.P.
Entity type:Organization
Organization Name:KATY INTERNAL MEDICINE ASSOCIATES, L.L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-394-0260
Mailing Address - Street 1:707 S FRY RD STE 480
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2259
Mailing Address - Country:US
Mailing Address - Phone:281-392-8620
Mailing Address - Fax:281-392-2258
Practice Address - Street 1:707 S FRY RD STE 480
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2259
Practice Address - Country:US
Practice Address - Phone:281-392-8620
Practice Address - Fax:281-392-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
TXF1931207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094040501Medicaid
TX094040501Medicaid