MEDICARE: MEDICAL CENTER CHARTER ACADEMY

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1346364577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER CHARTER ACADEMY

Provider Business Mailing Address
First Line	:	10420 MULLINS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-4927
Country	:	US
Telephone Number	:	713-726-0223
Fax Number	:

Provider Business Practice Location Address
First Line	:	10420 MULLINS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-4927
Country	:	US
Telephone Number	:	713-726-0223
Fax Number	:

Authorized Official
Title or Position	:	FINANCIAL CONTACT
Name	:	JOHN BROWN
Credential	:
Telephone Number	:	713-726-0223

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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