Provider Demographics
NPI:1811391279
Name:CENTRA CLINIC, INC
Entity Type:Organization
Organization Name:CENTRA CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YAA
Authorized Official - Middle Name:O
Authorized Official - Last Name:HONNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-328-0044
Mailing Address - Street 1:16316 FM 529 RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1464
Mailing Address - Country:US
Mailing Address - Phone:812-861-0600
Mailing Address - Fax:812-861-7292
Practice Address - Street 1:16316 FM 529 RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1464
Practice Address - Country:US
Practice Address - Phone:812-861-0600
Practice Address - Fax:812-861-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126663261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center