Provider Demographics
NPI:1316293491
Name:7111 MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:7111 MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANH
Authorized Official - Middle Name:MY
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-974-3167
Mailing Address - Street 1:7111 HARWIN DR
Mailing Address - Street 2:SUITE # 255D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2129
Mailing Address - Country:US
Mailing Address - Phone:281-974-3167
Mailing Address - Fax:281-974-3593
Practice Address - Street 1:7111 HARWIN DR
Practice Address - Street 2:SUITE # 255D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2129
Practice Address - Country:US
Practice Address - Phone:281-974-3167
Practice Address - Fax:281-974-3593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty