Provider Demographics
NPI:1558594515
Name:PIN OAK MEDICAL CLINIC OF KATY
Entity Type:Organization
Organization Name:PIN OAK MEDICAL CLINIC OF KATY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-646-8450
Mailing Address - Street 1:777 S FRY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2244
Mailing Address - Country:US
Mailing Address - Phone:281-646-8450
Mailing Address - Fax:
Practice Address - Street 1:19255 PARK ROW STE 203
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7310
Practice Address - Country:US
Practice Address - Phone:281-646-8450
Practice Address - Fax:888-880-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF6235OtherSTATE LICENSE #
TXB22966Medicare UPIN
TX0022EEOtherBCBS GROUP
TX00RJ71Medicare PIN
TX1265448302OtherINDIVIDUAL NPI
TX13847111Medicaid