Provider Demographics
NPI:1033168968
Name:TOTAL HEALTH CLINIC INC
Entity Type:Organization
Organization Name:TOTAL HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:281-277-8396
Mailing Address - Street 1:4611 S MAIN ST
Mailing Address - Street 2:STE. #7
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4731
Mailing Address - Country:US
Mailing Address - Phone:281-277-8396
Mailing Address - Fax:281-313-0590
Practice Address - Street 1:4611 S MAIN ST
Practice Address - Street 2:STE. #7
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4731
Practice Address - Country:US
Practice Address - Phone:281-277-8396
Practice Address - Fax:281-313-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154051041C0700X
TXC4177208D00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1685075Medicaid
TXC18511Medicare UPIN
TX00798WMedicare PIN