Healthcare Provider Details

I. General information

NPI: 1144425703
Provider Name (Legal Business Name): MEDICAL SCREENING CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 FAIRVIEW ST
PASADENA TX
77504-1904
US

IV. Provider business mailing address

3350 FAIRVIEW ST
PASADENA TX
77504-1904
US

V. Phone/Fax

Practice location:
  • Phone: 713-944-9830
  • Fax: 713-944-6116
Mailing address:
  • Phone: 713-944-9830
  • Fax: 713-944-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERRI D. STOCKDALE
Title or Position: ADMINISTRATOR
Credential:
Phone: 713-944-9830