Provider Demographics
NPI:1114191640
Name:COMMERCE PARK DIAGNOSTIC CLINIC, INC.
Entity Type:Organization
Organization Name:COMMERCE PARK DIAGNOSTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKONKWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-271-6262
Mailing Address - Street 1:8700 COMMERCE PARK DR STE 241
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7431
Mailing Address - Country:US
Mailing Address - Phone:713-271-6262
Mailing Address - Fax:713-271-6265
Practice Address - Street 1:8700 COMMERCE PARK DR STE 241
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7431
Practice Address - Country:US
Practice Address - Phone:713-271-6262
Practice Address - Fax:713-271-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty