Healthcare Provider Details

I. General information

NPI: 1215065453
Provider Name (Legal Business Name): REGIONAL SPECIALTY CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 HIGHWAY 6 SUITE 100
SUGAR LAND TX
77478-4908
US

IV. Provider business mailing address

1441 HIGHWAY 6 SUITE 100
SUGAR LAND TX
77478-4908
US

V. Phone/Fax

Practice location:
  • Phone: 281-240-2211
  • Fax: 281-240-2260
Mailing address:
  • Phone: 281-240-2211
  • Fax: 281-240-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberK1717
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberK1619
License Number StateTX

VIII. Authorized Official

Name: DR. RUBINA WAHID
Title or Position: SECRETARY
Credential: MD
Phone: 281-240-2211