MEDICARE: MARIDIAN CLINICAL CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1174799100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIDIAN CLINICAL CARE

Provider Business Mailing Address
First Line	:	PO BOX 90639
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77290-0639
Country	:	US
Telephone Number	:	281-970-6089
Fax Number	:	281-970-6105

Provider Business Practice Location Address
First Line	:	13323 DOTSON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4303
Country	:	US
Telephone Number	:	281-970-6089
Fax Number	:	281-970-6105

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JANICE MARIE KELLEY
Credential	:	M.D.
Telephone Number	:	281-970-6089

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	07/21/2008

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Directions to “MARIDIAN CLINICAL CARE ” Practice Location

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