MEDICARE: TEXAS ALLIANCE MEDICAL GROUP, PA

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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CG5146	OTHER	TX	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00438N	OTHER	TX	BCBS
2	00438N	OTHER	TX	BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306964986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS ALLIANCE MEDICAL GROUP, PA

Provider Business Mailing Address
First Line	:	14770 MEMORIAL # 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-5252
Country	:	US
Telephone Number	:	281-493-5535
Fax Number	:	281-493-3353

Provider Business Practice Location Address
First Line	:	6535 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2207
Country	:	US
Telephone Number	:	713-981-8184
Fax Number	:	713-981-8118

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	LESLIE ALLISON
Credential	:	M.D.
Telephone Number	:	281-977-8365

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	01/18/2021

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Directions to “TEXAS ALLIANCE MEDICAL GROUP, PA ” Practice Location

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