Provider Demographics
NPI:1306844014
Name:CITY EAST MEDICAL, P.A.
Entity Type:Organization
Organization Name:CITY EAST MEDICAL, P.A.
Other - Org Name:MEDICAL CENTER EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / M.D.
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:TSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-672-2593
Mailing Address - Street 1:7112 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020-5361
Mailing Address - Country:US
Mailing Address - Phone:713-672-2593
Mailing Address - Fax:713-672-7477
Practice Address - Street 1:7112 LYONS AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-5361
Practice Address - Country:US
Practice Address - Phone:713-672-2593
Practice Address - Fax:713-672-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4413207Q00000X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P080A9823Medicare ID - Type Unspecified
B27108Medicare UPIN