MEDICARE: FLU CLINICS OF SOUTHEAST TEXAS, INC.

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	174400000X	Specialist	D5558	TX

General Provider Information

NPI Number	:	1760774467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLU CLINICS OF SOUTHEAST TEXAS, INC.

Provider Business Mailing Address
First Line	:	9601 KATY FWY
Second Line	:	SUITE 315
City	:	HOUSTON
State	:	TX
Zip	:	77024-1342
Country	:	US
Telephone Number	:	713-547-5786
Fax Number	:	713-467-6881

Provider Business Practice Location Address
First Line	:	9601 KATY FWY
Second Line	:	SUITE 315
City	:	HOUSTON
State	:	TX
Zip	:	77024-1342
Country	:	US
Telephone Number	:	713-547-5786
Fax Number	:	713-467-6881

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. HECTOR MEDELLIN
Credential	:	M.D.
Telephone Number	:	713-547-5786

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	05/12/2011

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