Provider Demographics
NPI:1316149651
Name:MED A CLINICO
Entity type:Organization
Organization Name:MED A CLINICO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-955-0000
Mailing Address - Street 1:12779 JONES RD
Mailing Address - Street 2:STE 108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4648
Mailing Address - Country:US
Mailing Address - Phone:281-955-0000
Mailing Address - Fax:281-955-5305
Practice Address - Street 1:12779 JONES RD
Practice Address - Street 2:STE 108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4648
Practice Address - Country:US
Practice Address - Phone:281-955-0000
Practice Address - Fax:281-955-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty