Provider Demographics
NPI:1023383270
Name:LIFEPOST MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:LIFEPOST MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:U
Authorized Official - Last Name:UBOKUDOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-202-3244
Mailing Address - Street 1:9207 COUNTRY CREEK DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7745
Mailing Address - Country:US
Mailing Address - Phone:832-202-3244
Mailing Address - Fax:
Practice Address - Street 1:9207 COUNTRY CREEK DR
Practice Address - Street 2:SUITE 111
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7745
Practice Address - Country:US
Practice Address - Phone:832-202-3244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7754207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL7754OtherTEXAS