Healthcare Provider Details

I. General information

NPI: 1013500883
Provider Name (Legal Business Name): BAYOU CITY MEDICAL TOXICOLOGY AND EMERGENCY MEDICINE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22999 US-59
KINGWOOD TX
77339
US

IV. Provider business mailing address

4253 LAW ST
HOUSTON TX
77005-1035
US

V. Phone/Fax

Practice location:
  • Phone: 602-384-6460
  • Fax:
Mailing address:
  • Phone: 602-384-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SPENCER C GREENE
Title or Position: OWNER
Credential: MD
Phone: 602-384-6460