Provider Demographics
NPI:1912165952
Name:MEDICAL CLINIC OF HOUSTON, LLP
Entity type:Organization
Organization Name:MEDICAL CLINIC OF HOUSTON, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-520-4713
Mailing Address - Street 1:1701 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1713
Mailing Address - Country:US
Mailing Address - Phone:713-520-4713
Mailing Address - Fax:713-520-4755
Practice Address - Street 1:1701 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1713
Practice Address - Country:US
Practice Address - Phone:713-520-4713
Practice Address - Fax:713-520-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0489693291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
690004784OtherRAILROAD MEDICARE
TX094006601Medicaid
TXCL0757Medicare PIN