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General NPI Number Information
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NPI Number | 1710053459
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Entity Type | Organization
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Legal Business Name | MGM -VISION HEALTHCARE SERVICES INC
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 4606 FM 1960 RD W STE 215
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City | HOUSTON
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State | TX
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Zip | 77069-4617
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Country | US
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Telephone | 832-777-7744
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Fax | 832-900-0011
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Provider Business Mailing Address
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Address Line | 4606 FM 1960 RD W STE 215
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City | HOUSTON
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State | TX
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Zip | 77069-4617
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Country | US
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Telephone | 832-777-7744
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Fax | 832-900-0011
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Authorized Official
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Title or Position | OWNER
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Name | MUSTAFA ALSUWAIDI
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Credential | CEO
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Telephone | 832-777-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 008420
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License Number State | TX
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