Provider Demographics
NPI:1811229503
Name:MEDILINE WELLNESS CENTER
Entity Type:Organization
Organization Name:MEDILINE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:RATINOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-432-9400
Mailing Address - Street 1:6550 MAPLERIDGE ST STE 214
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4647
Mailing Address - Country:US
Mailing Address - Phone:713-432-9400
Mailing Address - Fax:713-432-9401
Practice Address - Street 1:6550 MAPLERIDGE ST STE 214
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4647
Practice Address - Country:US
Practice Address - Phone:713-432-9400
Practice Address - Fax:713-432-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty