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NPI Code Detail

MEDICARE: MIDTOWN CLINICAL ASSOC, PA

MEDICARE: MIDTOWN CLINICAL ASSOC, 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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760600217
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDTOWN CLINICAL ASSOC, PA
Provider Business Mailing Address
First Line : PO BOX 300958
Second Line :
City : HOUSTON
State : TX
Zip : 77230-0958
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4405 GRIGGS RD
Second Line :
City : HOUSTON
State : TX
Zip : 77021-2815
Country : US
Telephone Number : 713-748-4662
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ENDIA NICHELLE WALLS
Credential : M.D.
Telephone Number : 713-748-4662
Provider Enumeration Date : 04/22/2007
Last Update Date : 11/02/2022

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Directions to “MIDTOWN CLINICAL ASSOC, PA ” Practice Location

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