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General NPI Number Information
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NPI Number | 1346647203
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Entity Type | Organization
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Legal Business Name | CCLINIC ALLIANCE, PLLC
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8111 SOUTHWEST FWY
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City | HOUSTON
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State | TX
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Zip | 77074-1705
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Country | US
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Telephone | 713-730-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 8111 SOUTHWEST FREEWAY
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City | HOUSTON
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State | TX
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Zip | 77074-1705
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Country | US
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Telephone | 713-730-4800
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Fax |
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Authorized Official
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Title or Position | VP OF BUSINESS OPERATIONS
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Name | REGGIE ABRAHAM
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Credential |
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Telephone | 713-730-4766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State | TX
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