Provider Demographics
NPI:1720194566
Name:FAMILY CLINIC OF ANAHUAC
Entity Type:Organization
Organization Name:FAMILY CLINIC OF ANAHUAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-267-3118
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514-1703
Mailing Address - Country:US
Mailing Address - Phone:409-267-3118
Mailing Address - Fax:409-267-3740
Practice Address - Street 1:105 SOUTH KANSAS STREET
Practice Address - Street 2:
Practice Address - City:ANAHUAC
Practice Address - State:TX
Practice Address - Zip Code:77514-1703
Practice Address - Country:US
Practice Address - Phone:409-267-3118
Practice Address - Fax:409-267-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477564-01Medicaid
TX8784NOOtherMEDICARE
TX8784NOOtherMEDICARE
TXG45012Medicare UPIN