Healthcare Provider Details

I. General information

NPI: 1215356985
Provider Name (Legal Business Name): EAST HOUSTON PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155055 EAST FREEWAY
CHANNELVIEW TX
77530
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4692
US

V. Phone/Fax

Practice location:
  • Phone: 281-452-4747
  • Fax:
Mailing address:
  • Phone: 615-373-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS WADLINGTON
Title or Position: GROUP VICE PRESIDENT
Credential:
Phone: 615-372-7332