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General NPI Number Information
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NPI Number | 1174799100
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Entity Type | Organization
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Legal Business Name | MARIDIAN CLINICAL CARE
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 13323 DOTSON RD
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City | HOUSTON
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State | TX
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Zip | 77070-4303
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Country | US
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Telephone | 281-970-6089
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Fax | 281-970-6105
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Provider Business Mailing Address
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Address Line | PO BOX 90639
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City | HOUSTON
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State | TX
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Zip | 77290-0639
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Country | US
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Telephone | 281-970-6089
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Fax | 281-970-6105
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Authorized Official
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Title or Position | OWNER
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Name | DR. JANICE MARIE KELLEY
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Credential | M.D.
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Telephone | 281-970-6089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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