Provider Demographics
NPI:1558653030
Name:ELIJAH MEDICAL CLINIC
Entity Type:Organization
Organization Name:ELIJAH MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-767-5536
Mailing Address - Street 1:1213 HERMANN DR
Mailing Address - Street 2:SUITE 730
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:832-767-5536
Mailing Address - Fax:832-426-4456
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:SUITE 730
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:832-767-5536
Practice Address - Fax:832-426-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2246174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty