=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225577406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MHS PHYSICIANS OF TEXAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2017
-----------------------------------------------------
Last Update Date | 02/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6400 FANNIN ST STE 2800
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-1534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-500-6128
-----------------------------------------------------
Fax | 713-704-6889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6400 FANNIN ST STE 2070
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-1541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-704-6731
-----------------------------------------------------
Fax | 713-704-6889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGED CARE CREDENTIALING COORD
-----------------------------------------------------
Name | MRS. GWEN SYLVESTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-704-6772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WN0800X
-----------------------------------------------------
Taxonomy Name | Neuroscience Registered Nurse
-----------------------------------------------------
License Number | 609934
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------