Provider Demographics
NPI:1033435920
Name:NORTH BELT MEDICAL CLINIC
Entity Type:Organization
Organization Name:NORTH BELT MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-237-1500
Mailing Address - Street 1:10900 JONES RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5470
Mailing Address - Country:US
Mailing Address - Phone:832-237-1500
Mailing Address - Fax:832-237-1508
Practice Address - Street 1:10900 JONES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5470
Practice Address - Country:US
Practice Address - Phone:832-237-1500
Practice Address - Fax:832-237-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01415363A00000X
TXPA01345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty