Provider Demographics
NPI:1740432020
Name:TEXAS HEALTH CLINIC PA
Entity Type:Organization
Organization Name:TEXAS HEALTH CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDHYA-RANI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOKKALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-868-0495
Mailing Address - Street 1:15522 CONIFER BAY CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3186
Mailing Address - Country:US
Mailing Address - Phone:832-423-5328
Mailing Address - Fax:
Practice Address - Street 1:2 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4127
Practice Address - Country:US
Practice Address - Phone:281-661-1031
Practice Address - Fax:281-661-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0261OtherMEDICARE PTAN