Provider Demographics
NPI:1962752535
Name:ROBERT W FARRELL MD PA
Entity type:Organization
Organization Name:ROBERT W FARRELL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-316-0331
Mailing Address - Street 1:450 BLOSSOM ST. SUITE G
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:281-316-0331
Mailing Address - Fax:281-316-0200
Practice Address - Street 1:450 BLOSSOM ST. SUITE G
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-316-0331
Practice Address - Fax:281-316-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT W FARRELL MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-11
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20014OtherHERITAGE
TXTXB165523OtherHMO BLUE
TX122242403Medicaid
TX926228OtherAETNA
TXP00049BP8Medicaid
TXS01503OtherBLUE LINK
TXTXB165523OtherBLUE CROSS BLUE SHIELD
TX011427316OtherTRICARE
TX10013103OtherAMERIGROUP
TXP00049BP8Medicaid
TXB165523Medicare PIN