MEDICARE: 7111 MEDICAL CLINIC, INC.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1316293491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	7111 MEDICAL CLINIC, INC.

Provider Business Mailing Address
First Line	:	7111 HARWIN DR
Second Line	:	SUITE # 255D
City	:	HOUSTON
State	:	TX
Zip	:	77036-2129
Country	:	US
Telephone Number	:	281-974-3167
Fax Number	:	281-974-3593

Provider Business Practice Location Address
First Line	:	7111 HARWIN DR
Second Line	:	SUITE # 255D
City	:	HOUSTON
State	:	TX
Zip	:	77036-2129
Country	:	US
Telephone Number	:	281-974-3167
Fax Number	:	281-974-3593

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANH MY DO
Credential	:	MD
Telephone Number	:	281-974-3167

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	07/26/2012

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