Provider Demographics
NPI:1598709636
Name:SHARPSTOWN MEDICAL CLINIC
Entity Type:Organization
Organization Name:SHARPSTOWN MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:P
Authorized Official - Last Name:KWONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-339-1471
Mailing Address - Street 1:7111 HARWIN DR.
Mailing Address - Street 2:STE. 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036
Mailing Address - Country:US
Mailing Address - Phone:713-339-1471
Mailing Address - Fax:713-339-1514
Practice Address - Street 1:7111 HARWIN DR.
Practice Address - Street 2:STE. 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:713-339-1471
Practice Address - Fax:713-339-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8227261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132171304Medicaid
TX132171304Medicaid
TXC18087Medicare UPIN