=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174576698
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHCA BAYSHORE LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 SPENCER HWY
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77504-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-359-1000
-----------------------------------------------------
Fax | 713-359-1004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 SPENCER HWY
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77504-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-359-1000
-----------------------------------------------------
Fax | 713-359-1004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | DEMETRI MAGOULAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-440-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------