Provider Demographics
NPI:1093088239
Name:EASTEX MEDICAL CLINIC
Entity Type:Organization
Organization Name:EASTEX MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXEI
Authorized Official - Middle Name:N
Authorized Official - Last Name:FOMINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-859-6242
Mailing Address - Street 1:10769 EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77093-4301
Mailing Address - Country:US
Mailing Address - Phone:713-691-1276
Mailing Address - Fax:713-691-7258
Practice Address - Street 1:10769 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-4301
Practice Address - Country:US
Practice Address - Phone:713-691-1276
Practice Address - Fax:713-691-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty