MEDICARE: UNIFIED MEDICAL GROUP, 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	251E00000X	Home Health Agency	014109	TX

General Provider Information

NPI Number	:	1902980808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIFIED MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	10101 HARWIN DR. STE. 260
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036
Country	:	US
Telephone Number	:	713-772-1300
Fax Number	:	713-772-1310

Provider Business Practice Location Address
First Line	:	10101 HARWIN DR
Second Line	:	SUITE 260
City	:	HOUSTON
State	:	TX
Zip	:	77036-1687
Country	:	US
Telephone Number	:	713-772-1300
Fax Number	:	713-772-1310

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. IJEOMA A CLEMENT
Credential	:
Telephone Number	:	713-772-1300

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	05/07/2015

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