Provider Demographics
NPI:1356541635
Name:UNIMED MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:UNIMED MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFF/OPERATIONS MAN
Authorized Official - Prefix:
Authorized Official - First Name:DAMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYON
Authorized Official - Suffix:
Authorized Official - Credentials:RPHT
Authorized Official - Phone:713-498-0034
Mailing Address - Street 1:1334 PIN OAK RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6849
Mailing Address - Country:US
Mailing Address - Phone:832-498-0034
Mailing Address - Fax:713-456-2494
Practice Address - Street 1:1334 PIN OAK
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:832-498-0034
Practice Address - Fax:713-456-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service