Provider Demographics
| NPI: | 1437837556 |
|---|---|
| Name: | 180 MEDICAL CLINIC INC |
| Entity type: | Organization |
| Organization Name: | 180 MEDICAL CLINIC INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MEDICAL DIRECTOR |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | VIRAF |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | COOPER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 281-919-1476 |
| Mailing Address - Street 1: | 2580 FM 1960 RD W STE D |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HOUSTON |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 77068-3706 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 281-919-1476 |
| Mailing Address - Fax: | 877-288-1193 |
| Practice Address - Street 1: | 2580 FM 1960 RD W STE D |
| Practice Address - Street 2: | |
| Practice Address - City: | HOUSTON |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77068-3706 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 281-919-1476 |
| Practice Address - Fax: | 877-288-1193 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-07-10 |
| Last Update Date: | 2023-07-10 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
| No | 251K00000X | Agencies | Public Health or Welfare | |
| No | 332BX2000X | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
| No | 332S00000X | Suppliers | Hearing Aid Equipment | |
| No | 251V00000X | Agencies | Voluntary or Charitable | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | |
| No | 261QF0050X | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical |
| No | 261QM1100X | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
| No | 261QP2400X | Ambulatory Health Care Facilities | Clinic/Center | Prison Health |
| No | 332900000X | Suppliers | Non-Pharmacy Dispensing Site | |
| No | 332BC3200X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
| No | 332BD1200X | Suppliers | Durable Medical Equipment & Medical Supplies | Dialysis Equipment & Supplies |
| No | 332BN1400X | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies |
| No | 332BP3500X | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition |
