Provider Demographics
NPI:1205232600
Name:MID-TOWN MAT, INC.
Entity Type:Organization
Organization Name:MID-TOWN MAT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:COMSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-541-3218
Mailing Address - Street 1:6910 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3509
Mailing Address - Country:US
Mailing Address - Phone:713-541-3218
Mailing Address - Fax:713-541-3217
Practice Address - Street 1:4405 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4909
Practice Address - Country:US
Practice Address - Phone:713-528-2071
Practice Address - Fax:713-528-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder