MEDICARE: MEDICAL CENTER INTENSIVISTS, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093802571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER INTENSIVISTS, P.A.

Provider Business Mailing Address
First Line	:	3310 LOUVRE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-6686
Country	:	US
Telephone Number	:	281-752-5994
Fax Number	:	281-679-6780

Provider Business Practice Location Address
First Line	:	3310 LOUVRE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-6686
Country	:	US
Telephone Number	:	281-752-5994
Fax Number	:	281-679-6780

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	ALBERT O. DAVIES
Credential	:	M.D.
Telephone Number	:	281-752-5994

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	02/13/2013

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