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NPI Code Detail

MEDICARE: FIDEM HOSPITALIST PARTNERS PLLC

MEDICARE: FIDEM HOSPITALIST PARTNERS PLLC
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
1208M00000XHospitalist Physician

General Provider Information

NPI Number : 1215335088
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIDEM HOSPITALIST PARTNERS PLLC
Provider Business Mailing Address
First Line : 43 LAURELHURST CIR
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77382-1520
Country : US
Telephone Number : 936-524-8049
Fax Number :
Provider Business Practice Location Address
First Line : 20635 KUYKENDAHL RD
Second Line :
City : SPRING
State : TX
Zip : 77379-3533
Country : US
Telephone Number : 281-363-7170
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : DR. DERRICK ANTHONY MITCHELL
Credential : M.D.
Telephone Number : 936-524-8049
Provider Enumeration Date : 12/10/2014
Last Update Date : 12/11/2014

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Directions to “FIDEM HOSPITALIST PARTNERS PLLC ” Practice Location

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