Provider Demographics
NPI:1205056355
Name:DICKINSON MEDICAL CLINIC ASSOCIATES
Entity type:Organization
Organization Name:DICKINSON MEDICAL CLINIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-534-2525
Mailing Address - Street 1:303 FM 517 ROAD E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8630
Mailing Address - Country:US
Mailing Address - Phone:281-534-2525
Mailing Address - Fax:281-337-2721
Practice Address - Street 1:303 FM 517 ROAD E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8630
Practice Address - Country:US
Practice Address - Phone:281-534-2525
Practice Address - Fax:281-337-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty