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General NPI Number Information
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NPI Number | 1760600217
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Entity Type | Organization
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Legal Business Name | MIDTOWN CLINICAL ASSOC, PA
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 4405 GRIGGS RD
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City | HOUSTON
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State | TX
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Zip | 77021-2815
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Country | US
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Telephone | 713-748-4662
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 300958
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City | HOUSTON
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State | TX
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Zip | 77230-0958
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ENDIA NICHELLE WALLS
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Credential | M.D.
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Telephone | 713-748-4662
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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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