Provider Demographics
NPI:1396006243
Name:HOUSTON MEDICAL WELLNESS
Entity Type:Organization
Organization Name:HOUSTON MEDICAL WELLNESS
Other - Org Name:RENEW CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-495-3600
Mailing Address - Street 1:11701 S WILCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4756
Mailing Address - Country:US
Mailing Address - Phone:281-495-3600
Mailing Address - Fax:281-495-3611
Practice Address - Street 1:11701 WILCREST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099
Practice Address - Country:US
Practice Address - Phone:281-495-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty