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General NPI Number Information
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NPI Number | 1376161075
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Entity Type | Organization
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Legal Business Name | MOUNT CARMEL MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 11230 AIRLINE DR STE#1
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City | HOUSTON
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State | TX
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Zip | 77037-1116
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Country | US
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Telephone | 832-810-9521
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Fax | 855-703-1949
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Provider Business Mailing Address
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Address Line | 11230 AIRLINE DR STE#1
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City | HOUSTON
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State | TX
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Zip | 77037-1116
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Country | US
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Telephone | 832-810-9521
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Fax | 855-703-1949
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BLESSY S JACOB
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Credential | DNP
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Telephone | 832-810-9521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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