=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033422464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMESTEAD MEDICAL CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2010
-----------------------------------------------------
Last Update Date | 04/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8213 HOMESTEAD RD #A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77028-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-974-1147
-----------------------------------------------------
Fax | 832-767-5108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8213 HOMESTEAD RD #A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77028-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-974-1147
-----------------------------------------------------
Fax | 832-767-5108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | JOHN RAMIREZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-614-8747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174V00000X
-----------------------------------------------------
Taxonomy Name | Clinical Ethicist
-----------------------------------------------------
License Number | H0743
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------