MEDICARE: CENSEOHEALTH TX GREATER HOUSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1164822060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENSEOHEALTH TX GREATER HOUSTON

Provider Business Mailing Address
First Line	:	4055 VALLEY VIEW LN
Second Line	:	SUITE 400
City	:	DALLAS
State	:	TX
Zip	:	75244-5074
Country	:	US
Telephone Number	:	972-715-3800
Fax Number	:	888-722-4282

Provider Business Practice Location Address
First Line	:	2450 LOUISIANA ST
Second Line	:	#502
City	:	HOUSTON
State	:	TX
Zip	:	77006-2380
Country	:	US
Telephone Number	:	713-533-8862
Fax Number	:	888-722-4282

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MELISSA M COOKE
Credential	:
Telephone Number	:	972-715-3808

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	02/01/2015

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