Provider Demographics
NPI:1376161075
Name:MOUNT CARMEL MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:MOUNT CARMEL MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLESSY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:713-703-7684
Mailing Address - Street 1:11230 AIRLINE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1116
Mailing Address - Country:US
Mailing Address - Phone:832-215-2955
Mailing Address - Fax:855-703-1949
Practice Address - Street 1:11230 AIRLINE DR STE 1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1116
Practice Address - Country:US
Practice Address - Phone:832-810-9521
Practice Address - Fax:855-703-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3153637Medicaid
TX4213043Medicaid