Provider Demographics
NPI:1861446304
Name:TEXAS ALLIANCE MEDICAL GROUP, PA
Entity Type:Organization
Organization Name:TEXAS ALLIANCE MEDICAL GROUP, PA
Other - Org Name:DOCTORS CLINIC HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-977-8372
Mailing Address - Street 1:14770 MEMORIAL # 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5252
Mailing Address - Country:US
Mailing Address - Phone:281-493-5535
Mailing Address - Fax:281-493-3353
Practice Address - Street 1:14770 MEMORIAL DR.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5252
Practice Address - Country:US
Practice Address - Phone:713-330-1530
Practice Address - Fax:713-330-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMERIGROUPOther10001202
TX080591306Medicaid
TXTMHP THSTEPSOther080591302
TX00438NOtherBLUE CROSS BLUE SHIELD
TX080591301Medicaid
TX080591305Medicaid
TX080591307Medicaid
TX00438NOtherBC/BS
TXMEDICARE RAIL ROADOtherCG5146