Provider Demographics
NPI:1316348501
Name:M&M CLINICAL GROUP
Entity type:Organization
Organization Name:M&M CLINICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-369-1969
Mailing Address - Street 1:10021 MAIN ST
Mailing Address - Street 2:SUITE B3
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5224
Mailing Address - Country:US
Mailing Address - Phone:713-369-1969
Mailing Address - Fax:
Practice Address - Street 1:10021 MAIN ST
Practice Address - Street 2:B3
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5224
Practice Address - Country:US
Practice Address - Phone:713-369-1969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6037207L00000X, 207LA0401X, 207LP2900X
TXP30362084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP3036Medicaid
TXP6037Medicaid