MEDICARE: BELLAIRE GESSNER 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	208D00000X	General Practice 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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467769976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLAIRE GESSNER MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	9630 CLAREWOOD DR STE A5
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3535
Country	:	US
Telephone Number	:	713-981-6588
Fax Number	:	713-981-8978

Provider Business Practice Location Address
First Line	:	9630 CLAREWOOD DR STE A5
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3535
Country	:	US
Telephone Number	:	713-981-6588
Fax Number	:	713-981-8978

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	MS. DONNA S SMITH
Credential	:
Telephone Number	:	713-981-8989

Provider Enumeration Date	:	09/03/2010
Last Update Date	:	09/03/2010

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