Healthcare Provider Details

I. General information

NPI: 1548837503
Provider Name (Legal Business Name): HOUSTON IVF MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 GESSNER RD STE 2300
HOUSTON TX
77024-2585
US

IV. Provider business mailing address

9380 STATION ST
LONE TREE CO
80124-6831
US

V. Phone/Fax

Practice location:
  • Phone: 713-465-1211
  • Fax:
Mailing address:
  • Phone: 860-944-6273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON PARDEW
Title or Position: CEO
Credential:
Phone: 303-968-1950