Healthcare Provider Details

I. General information

NPI: 1396406054
Provider Name (Legal Business Name): HAZTECH MSO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4890 CHAMBERS RD
DENVER CO
80239-5152
US

IV. Provider business mailing address

18648 MCKAY DR STE 120
HUMBLE TX
77338-5724
US

V. Phone/Fax

Practice location:
  • Phone: 713-737-5912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: PAUL TATE
Title or Position: MANAGER
Credential:
Phone: 713-737-5912