Provider Demographics
NPI:1871117838
Name:INFECTIOUS DISEASE ASSOCIATES OF GREATER HOUSTON LLC
Entity type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATES OF GREATER HOUSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-841-7318
Mailing Address - Street 1:26852 IRON SQUIRE DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-7702
Mailing Address - Country:US
Mailing Address - Phone:718-841-7318
Mailing Address - Fax:
Practice Address - Street 1:22999 HIGHWAY 59 N STE 419
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4502
Practice Address - Country:US
Practice Address - Phone:281-361-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty