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NPI Code Detail

MEDICARE: JACINTO MEDICAL CENTER, L.P.

MEDICARE: JACINTO MEDICAL CENTER, L.P.
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
1261QR0200XRadiology Clinic/CenterR20528TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1J90TOTHERTXBCBS OF TEXAS

General Provider Information

NPI Number : 1356383665
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACINTO MEDICAL CENTER, L.P.
Provider Business Mailing Address
First Line : 2800 GARTH RD
Second Line :
City : BAYTOWN
State : TX
Zip : 77521-3947
Country : US
Telephone Number : 281-427-3700
Fax Number : 281-427-6663
Provider Business Practice Location Address
First Line : 2800 GARTH RD
Second Line :
City : BAYTOWN
State : TX
Zip : 77521-3947
Country : US
Telephone Number : 281-427-3700
Fax Number : 281-427-6663
Authorized Official
Title or Position : CEO
Name : MR. SIRAJ JIWANI
Credential :
Telephone Number : 281-427-3700
Provider Enumeration Date : 06/12/2006
Last Update Date : 03/04/2008

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