Provider Demographics
NPI:1134545072
Name:SDLDM, INC DBA PASSPORT HEALTH HOUSTON
Entity type:Organization
Organization Name:SDLDM, INC DBA PASSPORT HEALTH HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LINDSAY
Authorized Official - Last Name:MEDELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-467-6575
Mailing Address - Street 1:9601 KATY FWY STE 315
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1360
Mailing Address - Country:US
Mailing Address - Phone:713-467-6575
Mailing Address - Fax:713-467-6881
Practice Address - Street 1:9601 KATY FWY
Practice Address - Street 2:SUITE 315
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1342
Practice Address - Country:US
Practice Address - Phone:713-467-6575
Practice Address - Fax:713-467-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service