Healthcare Provider Details

I. General information

NPI: 1619081049
Provider Name (Legal Business Name): CADWALDER MEDICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 QUITMAN ST
HOUSTON TX
77009-7936
US

IV. Provider business mailing address

1320 QUITMAN ST
HOUSTON TX
77009-7936
US

V. Phone/Fax

Practice location:
  • Phone: 713-227-8246
  • Fax: 713-222-0464
Mailing address:
  • Phone: 713-227-8246
  • Fax: 713-222-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NATHAN D. INGRAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 713-227-8246