MEDICARE: 180 MEDICAL CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251K00000X	Public Health or Welfare Agency
2	332BX2000X	Oxygen Equipment & Supplies (DME)
3	332S00000X	Hearing Aid Equipment
4	251V00000X	Voluntary or Charitable Agency
5	261Q00000X	Clinic/Center
6	261QF0050X	Non-Surgical Family Planning Clinic/Center
7	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center
8	261QP2300X	Primary Care Clinic/Center
9	261QP2400X	Prison Health Clinic/Center
10	332900000X	Non-Pharmacy Dispensing Site
11	332BC3200X	Customized Equipment (DME)
12	332BD1200X	Dialysis Equipment & Supplies (DME)
13	332BN1400X	Nursing Facility Supplies (DME)
14	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
15	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1437837556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	180 MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	2580 FM 1960 RD W STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3706
Country	:	US
Telephone Number	:	281-919-1476
Fax Number	:	877-288-1193

Provider Business Practice Location Address
First Line	:	2580 FM 1960 RD W STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3706
Country	:	US
Telephone Number	:	281-919-1476
Fax Number	:	877-288-1193

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. VIRAF COOPER
Credential	:	MD
Telephone Number	:	281-919-1476

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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