Provider Demographics
NPI:1063181642
Name:EXCEPTIONAL HEIGHTS MEDICAL CLINIC
Entity type:Organization
Organization Name:EXCEPTIONAL HEIGHTS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:281-615-7601
Mailing Address - Street 1:8240 ANTOINE DR STE 102A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-2522
Mailing Address - Country:US
Mailing Address - Phone:281-741-8368
Mailing Address - Fax:281-741-8943
Practice Address - Street 1:8240 ANTOINE DR STE 102A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-2522
Practice Address - Country:US
Practice Address - Phone:281-741-8368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty