Provider Demographics
NPI:1841889409
Name:TEXAS ALLIANCE MEDICAL GROUP, PA
Entity type:Organization
Organization Name:TEXAS ALLIANCE MEDICAL GROUP, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-977-8365
Mailing Address - Street 1:14770 MEMORIAL DR # 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5252
Mailing Address - Country:US
Mailing Address - Phone:281-977-8372
Mailing Address - Fax:
Practice Address - Street 1:12188 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4442
Practice Address - Country:US
Practice Address - Phone:281-977-8384
Practice Address - Fax:713-636-2559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS ALLIANCE MEDICAL GROUP, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080591306Medicaid
TX080591305Medicaid