MEDICARE: COMMUNITY CLINICS OF TEXAS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1043600984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CLINICS OF TEXAS, INC

Provider Business Mailing Address
First Line	:	5610 AVIS HILL COURT
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2918 N RICHMOND RD
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-2006
Country	:	US
Telephone Number	:	832-654-5250
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. RITA SMITH
Credential	:	8326545250
Telephone Number	:	832-654-5250

Provider Enumeration Date	:	01/30/2015
Last Update Date	:	01/30/2015

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