MEDICARE: EXCELLENCE CLINIC OF TEXAS, PLLC

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	261QP2300X	Primary Care Clinic/Center
2	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1396119137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENCE CLINIC OF TEXAS, PLLC

Provider Business Mailing Address
First Line	:	15119 WALLISVILLE RD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-4629
Country	:	US
Telephone Number	:	281-977-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	15119 WALLISVILLE RD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-4629
Country	:	US
Telephone Number	:	281-977-9800
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. KASHIF ANSARI
Credential	:
Telephone Number	:	832-221-8072

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/23/2015

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