Provider Demographics
NPI:1366765307
Name:ST. PATRICK MEDICAL
Entity type:Organization
Organization Name:ST. PATRICK MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOURYI
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:713-878-4661
Mailing Address - Street 1:4315 LOCKWOOD DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-4117
Mailing Address - Country:US
Mailing Address - Phone:713-878-4661
Mailing Address - Fax:713-784-7211
Practice Address - Street 1:4315 LOCKWOOD DR
Practice Address - Street 2:SUITE 8
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-4117
Practice Address - Country:US
Practice Address - Phone:713-878-4661
Practice Address - Fax:713-748-7212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QA0401X, 207R00000X, 208000000X, 2084N0400X, 208800000X, 208VP0000X
TXPA 0556363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty