Provider Demographics
NPI:1841351822
Name:FAMILY CARE MEDICAL CLINIC
Entity type:Organization
Organization Name:FAMILY CARE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ULYSSES
Authorized Official - Middle Name:WESBY
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:713-433-4536
Mailing Address - Street 1:14215 SOUTH POST OAK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-5233
Mailing Address - Country:US
Mailing Address - Phone:713-433-4536
Mailing Address - Fax:713-433-6708
Practice Address - Street 1:14215 SOUTH POST OAK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5233
Practice Address - Country:US
Practice Address - Phone:713-433-4536
Practice Address - Fax:713-433-6708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091834401Medicaid
TX134080402Medicaid
TXB72432Medicare UPIN
TX00RF95Medicare ID - Type Unspecified