MEDICARE: EAST END MEDICAL CLINIC

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	208000000X	Pediatrics Physician
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437240413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST END MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	906 WAYSIDE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-2518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 WAYSIDE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-2518
Country	:	US
Telephone Number	:	713-923-6627
Fax Number	:	713-923-9383

Authorized Official
Title or Position	:	OFFICER
Name	:	MRS. CHANDRALATHA THOTA
Credential	:	MD
Telephone Number	:	713-921-6627

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	10/02/2014

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Directions to “EAST END MEDICAL CLINIC ” Practice Location

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