Healthcare Provider Details

I. General information

NPI: 1295052215
Provider Name (Legal Business Name): MLK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4973 MLK BLVD
HOUSTON TX
77021-2909
US

IV. Provider business mailing address

4973 MLK BLVD
HOUSTON TX
77021-2909
US

V. Phone/Fax

Practice location:
  • Phone: 832-596-3621
  • Fax:
Mailing address:
  • Phone: 832-596-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberD-5764
License Number StateTX

VIII. Authorized Official

Name: MURPHY LAWAL
Title or Position: EXEC. DIRECTOR/OWNER
Credential:
Phone: 832-596-9621