=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639987795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDX GLOBAL CLINICAL ADVISORS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2024
-----------------------------------------------------
Last Update Date | 12/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4140 SOUTHWEST FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77027-7311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-240-5893
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1911 BAGBY ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77002-8594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-240-5893
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF NURSE EXECUTIVE
-----------------------------------------------------
Name | TOMMY VAUGHN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 903-240-5893
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------