NPIMap

Organization Active NPI

Andala Medical Texas PA

  • Psychiatry Physician
  • Houston, TX
National Provider Identifier
1104499268
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ANDALA MEDICAL TEXAS PA
Practice address
12727 Kimberley LN Ste 302
Houston, TX 77024-4053
Phone
(210) 862-7246
NPI assigned
Jul 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jackie Lundin
Title
VP Payer Relations
Phone
(248) 921-4652

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

12727 Kimberley LN Ste 302
Houston, TX 77024-4053

Mailing address

4600 Lockhill Selma Rd
San Antonio, TX 78249-2185

National Provider Directory

National Provider Directory
Tax ID family
Kalypso Treatment Centers PLLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12727 Kimberley Ln
Ste 302
Houston, TX 77024

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1104499268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 LOCKHILL SELMA RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782492185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12727 KIMBERLEY LN STE 302",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770244053",
            "telephone_number": "210-862-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDALA MEDICAL TEXAS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-19",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "LUNDIN",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "VP PAYER RELATIONS",
        "authorized_official_telephone_number": "248-921-4652"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.