Provider Demographics
NPI:1912192154
Name:CENTER MEDICAL CLINIC
Entity Type:Organization
Organization Name:CENTER MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-476-4266
Mailing Address - Street 1:2106 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4164
Mailing Address - Country:US
Mailing Address - Phone:281-476-4266
Mailing Address - Fax:281-476-4278
Practice Address - Street 1:2106 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4164
Practice Address - Country:US
Practice Address - Phone:281-476-4266
Practice Address - Fax:281-476-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4534261QM2500X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AB43Medicare PIN