Provider Demographics
NPI:1386100782
Name:MERCY-TEDDY HEALTH CARE PLLC
Entity type:Organization
Organization Name:MERCY-TEDDY HEALTH CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEWODROS
Authorized Official - Middle Name:WOLDEMARIAM
Authorized Official - Last Name:TEKETEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-447-6454
Mailing Address - Street 1:25311 KINGSLAND BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7349
Mailing Address - Country:US
Mailing Address - Phone:832-447-6454
Mailing Address - Fax:866-237-7319
Practice Address - Street 1:25311 KINGSLAND BLVD STE 190
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7349
Practice Address - Country:US
Practice Address - Phone:832-913-8504
Practice Address - Fax:832-913-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care