Provider Demographics
NPI:1467458059
Name:TEXAS MEDICAL&WELLNESS CLINIC P.A.
Entity Type:Organization
Organization Name:TEXAS MEDICAL&WELLNESS CLINIC P.A.
Other - Org Name:NHI LE MD/PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NHI
Authorized Official - Middle Name:P
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-551-2288
Mailing Address - Street 1:6242 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1705
Mailing Address - Country:US
Mailing Address - Phone:361-551-2288
Mailing Address - Fax:361-576-9355
Practice Address - Street 1:6242 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1705
Practice Address - Country:US
Practice Address - Phone:361-551-2288
Practice Address - Fax:361-576-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9105207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AD895OtherBC/BS
TX030819901Medicaid
TXBL6539590OtherDEA
TXTXB101620Medicare PIN
H03309Medicare UPIN