Basic Information
| Provider Information | |||||||||
| NPI: | 1598825697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEDELL | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BEDELL | ||||||||
| OtherFirstName: | ERIC | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2411 FOUNTAIN VIEW DR | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770574817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136204000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2411 FOUNTAIN VIEW DR | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770574817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136204000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 05/20/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | K7997 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 28134 | AL | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 009943193 | 05 | AL | MEDICAID | 02577504 | 05 | MS | MEDICAID | 009943194 | 05 | AL | MEDICAID | 051541245 | 01 | AL | BLUE CROSS | OTHER | 051541246 | 01 | AL | BLUE CROSS | OTHER | 8AT554 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 009943196 | 05 | AL | MEDICAID | 009943197 | 05 | AL | MEDICAID | 051541244 | 01 | AL | BLUE CROSS | OTHER | 117258701 | 05 | TX | MEDICAID | 051541243 | 01 | AL | BLUE CROSS | OTHER | 117258704 | 05 | TX | MEDICAID | P00697089 | 01 | TX | RAILROAD MEDICARE | OTHER |