Provider Demographics
NPI:1376098509
Name:FOURTH WARD CLINIC
Entity Type:Organization
Organization Name:FOURTH WARD CLINIC
Other - Org Name:GOOD NEIGHBOR HEALTHCARE CENTER CY-FAIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:THIELKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-387-7140
Mailing Address - Street 1:190 HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3729
Mailing Address - Country:US
Mailing Address - Phone:713-529-3597
Mailing Address - Fax:713-529-6169
Practice Address - Street 1:7777 WESTGREEN BLVD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-0190
Practice Address - Country:US
Practice Address - Phone:713-529-3597
Practice Address - Fax:713-529-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)