MEDICARE: CENTRAL HOUSTON 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	208VP0000X	Pain Medicine Physician	D6352	TX

General Provider Information

NPI Number	:	1487953386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL HOUSTON CLINIC

Provider Business Mailing Address
First Line	:	15622 SIVER RIDGE DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3704
Country	:	US
Telephone Number	:	281-444-0929
Fax Number	:	281-440-9294

Provider Business Practice Location Address
First Line	:	15622 SIVER RIDGE DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3704
Country	:	US
Telephone Number	:	281-444-0929
Fax Number	:	281-440-9294

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JOHN W YOUNG
Credential	:	M.D
Telephone Number	:	281-440-9292

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	07/06/2011

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Directions to “CENTRAL HOUSTON CLINIC ” Practice Location

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