Provider Demographics
NPI:1932616786
Name:GEHLEN CLINIC
Entity Type:Organization
Organization Name:GEHLEN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:EKECHI
Authorized Official - Last Name:AKUCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-412-2821
Mailing Address - Street 1:63 SUNSET PARK LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10970 SHADOW CREEK PKWY STE 220
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-0102
Practice Address - Country:US
Practice Address - Phone:713-412-2821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2528261QI0500X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX802882946OtherFILE NUMBER