Provider Demographics
NPI:1043491699
Name:CONROE CLINIC CORPORATION
Entity Type:Organization
Organization Name:CONROE CLINIC CORPORATION
Other - Org Name:MEDICLINIC CONROE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHIRUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-783-4707
Mailing Address - Street 1:PO BOX 571195
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77257-1195
Mailing Address - Country:US
Mailing Address - Phone:713-783-4707
Mailing Address - Fax:713-783-2066
Practice Address - Street 1:3401 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1860
Practice Address - Country:US
Practice Address - Phone:936-441-3718
Practice Address - Fax:936-441-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
0045KWOtherBCBS URGENT CARE