Provider Demographics
NPI:1982878559
Name:AMETHYST MEDICAL CORPORATION
Entity type:Organization
Organization Name:AMETHYST MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:SALLER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:713-222-7546
Mailing Address - Street 1:4710 BELLAIRE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4505
Mailing Address - Country:US
Mailing Address - Phone:713-222-7546
Mailing Address - Fax:713-592-0123
Practice Address - Street 1:4710 BELLAIRE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4505
Practice Address - Country:US
Practice Address - Phone:713-222-7546
Practice Address - Fax:713-592-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8073174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1659552941OtherNPI / CHRISTY L. SALLER,