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NPI Code Detail

MEDICARE: ICON HOSPITAL, LLP

MEDICARE: ICON HOSPITAL, LLP
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1649721507
Entity Type Code : Organization
Provider Name (Legal Business Name) : ICON HOSPITAL, LLP
Provider Business Mailing Address
First Line : 22751 PROFESSIONAL DR
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-6021
Country : US
Telephone Number : 281-359-3223
Fax Number :
Provider Business Practice Location Address
First Line : 19211 MCKAY DR
Second Line :
City : HUMBLE
State : TX
Zip : 77338-5502
Country : US
Telephone Number : 713-660-0555
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : MR. RANDY BUTLER
Credential :
Telephone Number : 281-359-3223
Provider Enumeration Date : 10/17/2016
Last Update Date : 08/20/2019

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