Healthcare Provider Details

I. General information

NPI: 1770726580
Provider Name (Legal Business Name): CLINIMED CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5814 WINDY KNOLL LN
ROSHARON TX
77583-2058
US

IV. Provider business mailing address

PO BOX 540878
HOUSTON TX
77254-0878
US

V. Phone/Fax

Practice location:
  • Phone: 713-865-1414
  • Fax: 281-972-9601
Mailing address:
  • Phone: 713-865-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DERRICK PARKER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 713-865-1414