Provider Demographics
NPI:1205240579
Name:THORPE MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:THORPE MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:OTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-526-5444
Mailing Address - Street 1:7457 HARWIN DR
Mailing Address - Street 2:206
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2018
Mailing Address - Country:US
Mailing Address - Phone:972-526-5444
Mailing Address - Fax:972-526-5445
Practice Address - Street 1:7457 HARWIN DR
Practice Address - Street 2:206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2018
Practice Address - Country:US
Practice Address - Phone:972-526-5444
Practice Address - Fax:972-526-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty