Provider Demographics
NPI:1174534929
Name:CYPRESSWOOD CLINIC ASSOCIATES
Entity type:Organization
Organization Name:CYPRESSWOOD CLINIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KOKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-699-6202
Mailing Address - Street 1:PO BOX 111849
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77293-0849
Mailing Address - Country:US
Mailing Address - Phone:713-695-9947
Mailing Address - Fax:713-695-8053
Practice Address - Street 1:5990 AIRLINE DR
Practice Address - Street 2:STE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4233
Practice Address - Country:US
Practice Address - Phone:713-695-9947
Practice Address - Fax:713-695-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82G132OtherBCBS
TX00JH95Medicare ID - Type Unspecified
TXC14352Medicare UPIN