MEDICARE: DICKINSON MEDICAL CLINIC ASSOCIATES

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1205056355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DICKINSON MEDICAL CLINIC ASSOCIATES

Provider Business Mailing Address
First Line	:	303 FM 517 ROAD E
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-8630
Country	:	US
Telephone Number	:	281-534-2525
Fax Number	:	281-337-2721

Provider Business Practice Location Address
First Line	:	303 FM 517 ROAD E
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-8630
Country	:	US
Telephone Number	:	281-534-2525
Fax Number	:	281-337-2721

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDWARD E LOUIS
Credential	:	MD
Telephone Number	:	281-534-2525

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	09/16/2009

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