MEDICARE: STATEN CLINIC

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1104636711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATEN CLINIC

Provider Business Mailing Address
First Line	:	6516 NEW RD
Second Line	:
City	:	NORTH ZULCH
State	:	TX
Zip	:	77872-6337
Country	:	US
Telephone Number	:	281-740-2405
Fax Number	:

Provider Business Practice Location Address
First Line	:	6516 NEW RD
Second Line	:
City	:	NORTH ZULCH
State	:	TX
Zip	:	77872-6337
Country	:	US
Telephone Number	:	281-740-2405
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID STATEN
Credential	:	APRN
Telephone Number	:	281-740-2405

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	01/08/2025

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Directions to “STATEN CLINIC ” Practice Location

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