Provider Demographics
NPI:1750693685
Name:WEST LITTLE YORK MEDICAL CENTER, PLLC
Entity type:Organization
Organization Name:WEST LITTLE YORK MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:CORSALLE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:SR
Authorized Official - Credentials:LVN BA BIOLOGY
Authorized Official - Phone:713-742-9900
Mailing Address - Street 1:PO BOX 91124
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77291-1124
Mailing Address - Country:US
Mailing Address - Phone:713-742-9900
Mailing Address - Fax:713-742-9901
Practice Address - Street 1:511 W LITTLE YORK RD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-2421
Practice Address - Country:US
Practice Address - Phone:713-742-9900
Practice Address - Fax:713-742-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216816301Medicaid
TX216816301Medicaid