Provider Demographics
NPI:1245928159
Name:TA MEDICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:TA MEDICAL ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEODULO
Authorized Official - Middle Name:
Authorized Official - Last Name:AVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-578-0699
Mailing Address - Street 1:PO BOX 3856
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3856
Mailing Address - Country:US
Mailing Address - Phone:281-640-2199
Mailing Address - Fax:619-444-1740
Practice Address - Street 1:1485 FM 1960 BYPASS RD EAST
Practice Address - Street 2:SUITE 260
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:281-640-2199
Practice Address - Fax:619-444-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty