Provider Demographics
NPI:1134584451
Name:AIRLINE MEDICAL CENTER AND DIAGNOSTICS,PPLC
Entity type:Organization
Organization Name:AIRLINE MEDICAL CENTER AND DIAGNOSTICS,PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-691-7735
Mailing Address - Street 1:1906 TREBLE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5885
Mailing Address - Country:US
Mailing Address - Phone:713-691-7735
Mailing Address - Fax:
Practice Address - Street 1:1906 TREBLE DR STE 10
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5885
Practice Address - Country:US
Practice Address - Phone:713-691-7735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
TXK1739207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty