Provider Demographics
NPI:1295052215
Name:MLK MEDICAL CENTER
Entity type:Organization
Organization Name:MLK MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MURPHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-596-9621
Mailing Address - Street 1:4973 MLK BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2909
Mailing Address - Country:US
Mailing Address - Phone:832-596-3621
Mailing Address - Fax:
Practice Address - Street 1:4973 MLK BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2909
Practice Address - Country:US
Practice Address - Phone:832-596-3621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD-5764146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty