Provider Demographics
NPI:1578668984
Name:LEONIDAS S. ANDRES, M D. P A
Entity Type:Organization
Organization Name:LEONIDAS S. ANDRES, M D. P A
Other - Org Name:ANDRES MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONIDAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-267-3137
Mailing Address - Street 1:312 MILLER
Mailing Address - Street 2:P.O. BOX 1470
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514
Mailing Address - Country:US
Mailing Address - Phone:409-267-3137
Mailing Address - Fax:409-267-6428
Practice Address - Street 1:312 MILLER
Practice Address - Street 2:BOX 1470
Practice Address - City:ANAHUAC
Practice Address - State:TX
Practice Address - Zip Code:77514
Practice Address - Country:US
Practice Address - Phone:409-267-3137
Practice Address - Fax:409-267-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3714207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8486B9Medicare ID - Type UnspecifiedPROVIDER I D
TXC12864Medicare UPIN