MEDICARE: CITY EAST MEDICAL, P.A.

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	208D00000X	General Practice Physician	G4413	TX
2	207Q00000X	Family Medicine Physician	G4413	TX
3	207R00000X	Internal Medicine Physician	G4413	TX

General Provider Information

NPI Number	:	1306844014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY EAST MEDICAL, P.A.

Provider Business Mailing Address
First Line	:	7112 LYONS AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-5361
Country	:	US
Telephone Number	:	713-672-2593
Fax Number	:	713-672-7477

Provider Business Practice Location Address
First Line	:	7112 LYONS AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-5361
Country	:	US
Telephone Number	:	713-672-2593
Fax Number	:	713-672-7477

Authorized Official
Title or Position	:	PRESIDENT / M.D.
Name	:	EDWARD K TSE
Credential	:	M.D.
Telephone Number	:	713-672-2593

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/14/2007

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