MEDICARE: UNIMED MEDICAL CLINIC LLC

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	261QH0100X	Health Service Clinic/Center		TX

General Provider Information

NPI Number	:	1356541635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIMED MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	1334 PIN OAK RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6849
Country	:	US
Telephone Number	:	832-498-0034
Fax Number	:	713-456-2494

Provider Business Practice Location Address
First Line	:	1334 PIN OAK
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494
Country	:	US
Telephone Number	:	832-498-0034
Fax Number	:	713-456-2494

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFF/OPERATIONS MAN
Name	:	DAMEON TRYON
Credential	:	RPHT
Telephone Number	:	713-498-0034

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	11/10/2009

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