PSYCHIATRIC SERVICES OF HOUSTON & ASSOCIATES (SENIOR PSYCHIATRIC CONNECTION OR SENIOR PSYCHCARE) - NPI NUMBER 1457398489

Summary

Provider Name: PSYCHIATRIC SERVICES OF HOUSTON & ASSOCIATES (SENIOR PSYCHIATRIC CONNECTION OR SENIOR PSYCHCARE)

NPI Number: 1457398489

Clasification: Specialist (174400000X)

Address:
4314 YOAKUM BLVD
HOUSTON, TX
ZIP 77006

Phone Number: (713) 850-0049



Detailed Information

PSYCHIATRIC SERVICES OF HOUSTON & ASSOCIATES is a specialist in Houston, TX. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. The assigned NPI number for this provider is 1457398489 and is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Senior Psychiatric Connection Or Senior Psychcare.

The provider's business address is:

4314 YOAKUM BLVD
HOUSTON, TX
ZIP 77006-818
Phone: (713) 850-0049
Fax: (713) 627-7302

The provider's authorized official is Leo James Borrell .
The authorized official title is President and has the following contact phone number (713) 850-0049.

The enumeration date for this NPI number is 5/31/2006 and was last updated on 10/5/2011.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 174400000X Specialist Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 146806801 MEDICAID TX
2 145260901 MEDICAID TX
3 00621R MEDICARE PIN TX
4 145260902 MEDICAID TX
5 00620R MEDICARE PIN TX
6 00W454 MEDICARE PIN TX
7 00622R MEDICARE PIN TX

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1457398489 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name PSYCHIATRIC SERVICES OF HOUSTON & ASSOCIATES The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name SENIOR PSYCHIATRIC CONNECTION OR SENIOR PSYCHCARE Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 4314 YOAKUM BLVD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name HOUSTON The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name TX The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 770065818 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 7138500049 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 7136277302 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 5/31/2006 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 10/5/2011 The date that a record was last updated or changed.
16 Authorized Official Last Name BORRELL The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name LEO The first name of the authorized official.
18 Authorized Official Middle Name JAMES The middle name of the authorized official.
19 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
20 Authorized Official Telephone Number 7138500049 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 174400000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 146806801 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier State 1 TX
26 Other Provider Identifier 2 145260901 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier State 2 TX
29 Other Provider Identifier 3 00621R Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 3 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier State 3 TX
32 Other Provider Identifier 4 145260902 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
33 Other Provider Identifier Type Code 4 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier State 4 TX
35 Other Provider Identifier 5 00620R Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
36 Other Provider Identifier Type Code 5 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
37 Other Provider Identifier State 5 TX
38 Other Provider Identifier 6 00W454 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
39 Other Provider Identifier Type Code 6 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
40 Other Provider Identifier State 6 TX
41 Other Provider Identifier 7 00622R Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
42 Other Provider Identifier Type Code 7 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
43 Other Provider Identifier State 7 TX
44 Is Organization Subpart N
45 Authorized Official Name Prefix Text DR.
46 Authorized Official Credential Text M.D.
47 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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