Provider Demographics
NPI:1124731674
Name:KMC CLINIC WILCREST
Entity type:Organization
Organization Name:KMC CLINIC WILCREST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHRORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-398-7778
Mailing Address - Street 1:11658 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-3612
Mailing Address - Country:US
Mailing Address - Phone:281-302-5121
Mailing Address - Fax:281-302-6294
Practice Address - Street 1:11658 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-3612
Practice Address - Country:US
Practice Address - Phone:281-302-5121
Practice Address - Fax:281-302-6294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SABA ASAD ANSARI P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-29
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty