=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811018492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN T HOUSTON MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 04/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2707 BRECKENRIDGE ST STE 2
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-926-8828
-----------------------------------------------------
Fax | 270-926-0760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2707 BRECKENRIDGE ST STE 2
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-926-8828
-----------------------------------------------------
Fax | 270-926-0760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOHN T HOUSTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 270-926-8828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA787
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 173000000X
-----------------------------------------------------
Taxonomy Name | Legal Medicine
-----------------------------------------------------
License Number | 21411
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------