Provider Demographics
NPI:1407002637
Name:COMMUNITY OUTREACH CLINIC
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-481-9595
Mailing Address - Street 1:10851 SCARSDALE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-5714
Mailing Address - Country:US
Mailing Address - Phone:281-481-9595
Mailing Address - Fax:281-481-0692
Practice Address - Street 1:10851 SCARSDALE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-5714
Practice Address - Country:US
Practice Address - Phone:281-481-9595
Practice Address - Fax:281-481-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137361502Medicaid