Provider Demographics
NPI:1831495654
Name:MEDICAL CENTER SOUTHEAST HOUSTON, LLC
Entity Type:Organization
Organization Name:MEDICAL CENTER SOUTHEAST HOUSTON, LLC
Other - Org Name:FELIPE RIOS, M.D. AND ASSOCIATES, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-649-0870
Mailing Address - Street 1:8208 GULF FWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-4530
Mailing Address - Country:US
Mailing Address - Phone:713-649-0870
Mailing Address - Fax:713-649-7130
Practice Address - Street 1:8208 GULF FWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-4530
Practice Address - Country:US
Practice Address - Phone:713-649-0870
Practice Address - Fax:713-649-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4057207Q00000X
TXE7722207R00000X
TXM2300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081490703Medicaid
TX081490703Medicaid