Provider Demographics
NPI:1558332338
Name:VILLAGE MEDICAL GROUP
Entity Type:Organization
Organization Name:VILLAGE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-461-2915
Mailing Address - Street 1:9235 KATY FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1507
Mailing Address - Country:US
Mailing Address - Phone:713-468-5009
Mailing Address - Fax:713-468-4012
Practice Address - Street 1:9055 KATY FWY
Practice Address - Street 2:SUITE 306
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1624
Practice Address - Country:US
Practice Address - Phone:713-468-5009
Practice Address - Fax:713-468-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3784207RE0101X
TX1971213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX