MEDICARE: AIDS HEALTHCARE FOUNDATION TEXAS, INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1760918726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIDS HEALTHCARE FOUNDATION TEXAS, INC

Provider Business Mailing Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-860-5200
Fax Number	:	833-241-7615

Provider Business Practice Location Address
First Line	:	7400 FANNIN ST STE 1118
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1936
Country	:	US
Telephone Number	:	713-799-8994
Fax Number	:	713-799-9931

Authorized Official
Title or Position	:	CHIEF OF MANAGED CARE
Name	:	DONNA STIDHAM
Credential	:
Telephone Number	:	323-436-5025

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	09/12/2019

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