Provider Demographics
NPI:1508009309
Name:HOUSTON ADVANCE MEDILINE CLINIC
Entity Type:Organization
Organization Name:HOUSTON ADVANCE MEDILINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANUSIEM
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:713-669-0848
Mailing Address - Street 1:6550 MAPLERIDGE ST STE 214
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4647
Mailing Address - Country:US
Mailing Address - Phone:713-669-0848
Mailing Address - Fax:713-669-0648
Practice Address - Street 1:6550 MAPLERIDGE ST STE 214
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4647
Practice Address - Country:US
Practice Address - Phone:713-669-0848
Practice Address - Fax:713-669-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty