MEDICARE: TEJAS URGENT CARE CLINIC 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	207P00000X	Emergency Medicine Physician	M5571	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB106694	OTHER	TX	MEDICARE GROUP PTAN

General Provider Information

NPI Number	:	1821317439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEJAS URGENT CARE CLINIC INC

Provider Business Mailing Address
First Line	:	415 W LITTLE YORK RD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77076-1349
Country	:	US
Telephone Number	:	713-692-3727
Fax Number	:	713-692-3717

Provider Business Practice Location Address
First Line	:	415 W LITTLE YORK RD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77076-1349
Country	:	US
Telephone Number	:	713-692-3727
Fax Number	:	713-692-3717

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	JULIA WARD
Credential	:	MD
Telephone Number	:	713-692-3727

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	09/15/2010

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