Provider Demographics
NPI:1598001208
Name:WEST HOUSTON PRIMARY CARE PA
Entity Type:Organization
Organization Name:WEST HOUSTON PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TESFAMARIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:TEDLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-589-8500
Mailing Address - Street 1:14629 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-7500
Mailing Address - Country:US
Mailing Address - Phone:281-589-8500
Mailing Address - Fax:
Practice Address - Street 1:14629 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-7500
Practice Address - Country:US
Practice Address - Phone:281-589-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4791261Q00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service