Provider Demographics
NPI:1215065453
Name:REGIONAL SPECIALTY CLINIC, PA
Entity type:Organization
Organization Name:REGIONAL SPECIALTY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-240-2211
Mailing Address - Street 1:1441 HIGHWAY 6
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4908
Mailing Address - Country:US
Mailing Address - Phone:281-240-2211
Mailing Address - Fax:281-240-2260
Practice Address - Street 1:1441 HIGHWAY 6
Practice Address - Street 2:SUITE 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4908
Practice Address - Country:US
Practice Address - Phone:281-240-2211
Practice Address - Fax:281-240-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1717207K00000X
TXK1619207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX006859Medicare ID - Type Unspecified