MEDICARE: UNIHEALTH MEDICAL CLINIC, LLC

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	207Q00000X	Family Medicine Physician	F6235	TX

General Provider Information

NPI Number	:	1669704458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIHEALTH MEDICAL CLINIC, LLC

Provider Business Mailing Address
First Line	:	1334 PIN OAK RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6849
Country	:	US
Telephone Number	:	281-898-6515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1334 PIN OAK RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6849
Country	:	US
Telephone Number	:	281-898-6515
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DAMEON TRYON
Credential	:
Telephone Number	:	713-498-0034

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	02/04/2010

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