Provider Demographics
NPI:1720349756
Name:HSCC AFFILIATE GROUP
Entity type:Organization
Organization Name:HSCC AFFILIATE GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY-IN-FACT
Authorized Official - Prefix:
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-370-7266
Mailing Address - Street 1:5868 WESTHEIMER RD #453
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-9998
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6300 RICHMOND AVE
Practice Address - Street 2:SUITE 210 D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-9998
Practice Address - Country:US
Practice Address - Phone:832-370-7266
Practice Address - Fax:713-975-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171W00000XOther Service ProvidersContractorGroup - Single Specialty