Provider Demographics
NPI:1376687491
Name:ATA T SALEK
Entity Type:Organization
Organization Name:ATA T SALEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ATA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-468-7911
Mailing Address - Street 1:1140 BUSINESS CENTER DR.
Mailing Address - Street 2:STE. 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043
Mailing Address - Country:US
Mailing Address - Phone:713-468-7911
Mailing Address - Fax:713-468-5191
Practice Address - Street 1:1140 BUSINESS CENTER DR.
Practice Address - Street 2:STE. 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043
Practice Address - Country:US
Practice Address - Phone:713-468-7911
Practice Address - Fax:713-468-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099098802Medicaid
TXC21488Medicare UPIN
TX099098802Medicaid