MEDICARE: IACC/EHI NW, LLC

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	282N00000X	General Acute Care Hospital

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	370240	OTHER	OK	MEDICARE

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
2	2388	OTHER	OK	HOSPITAL LICENSE

General Provider Information

NPI Number	:	1194209155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IACC/EHI NW, LLC

Provider Business Mailing Address
First Line	:	8686 NEW TRAILS DR STE 100
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-1176
Country	:	US
Telephone Number	:	713-637-1146
Fax Number	:	281-465-8414

Provider Business Practice Location Address
First Line	:	9417 N COUNCIL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6207
Country	:	US
Telephone Number	:	877-516-0911
Fax Number	:	281-292-3585

Authorized Official
Title or Position	:	SECRETARY
Name	:	JOHN BUCK
Credential	:	MD
Telephone Number	:	713-637-1004

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	09/10/2019

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Directions to “IACC/EHI NW, LLC ” Practice Location

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