Provider Demographics
NPI:1073816559
Name:TEAS STAR FAMILY PRACTICE CLINIC
Entity type:Organization
Organization Name:TEAS STAR FAMILY PRACTICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-777-2404
Mailing Address - Street 1:9639 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1332
Mailing Address - Country:US
Mailing Address - Phone:713-777-2404
Mailing Address - Fax:713-777-2464
Practice Address - Street 1:9639 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1332
Practice Address - Country:US
Practice Address - Phone:713-777-2404
Practice Address - Fax:713-777-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care