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General NPI Number Information
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NPI Number | 1255567848
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Entity Type | Organization
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Legal Business Name | DOMINION MEDICAL HEALTHCARE SERVICE
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 8300 BISSONNET ST SUITE 130
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City | HOUSTON
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State | TX
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Zip | 77074-3900
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Country | US
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Telephone | 281-974-4400
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Fax | 281-974-4386
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Provider Business Mailing Address
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Address Line | 8300 BISSONNET ST SUITE 130
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City | HOUSTON
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State | TX
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Zip | 77074-3900
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Country | US
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Telephone | 281-974-4400
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Fax | 281-974-4386
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | IRENONA WATSON
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Credential |
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Telephone | 281-974-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 03172
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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