Healthcare Provider Details

I. General information

NPI: 1144624545
Provider Name (Legal Business Name): MED-AID HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11251 RICHMOND AVE SUITE # F100A
HOUSTON TX
77082-6658
US

IV. Provider business mailing address

11251 RICHMOND AVE SUITE # F100A
HOUSTON TX
77082-6658
US

V. Phone/Fax

Practice location:
  • Phone: 832-243-5494
  • Fax: 832-243-5555
Mailing address:
  • Phone: 832-243-5494
  • Fax: 832-243-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEXEY A. KHARITONOV
Title or Position: CEO
Credential:
Phone: 832-243-5494