Healthcare Provider Details

I. General information

NPI: 1639641418
Provider Name (Legal Business Name): CRITICAL CARE CONSULTANTS OF HOUSTON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BLOSSOM ST
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

PO BOX 128
BELLAIRE TX
77402-0128
US

V. Phone/Fax

Practice location:
  • Phone: 713-899-1594
  • Fax: 281-816-4402
Mailing address:
  • Phone: 281-833-3330
  • Fax: 281-833-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALFRED SALIM MAKSOUD
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 281-910-0443