Provider Demographics
NPI:1972981355
Name:DAT MEDICAL CLINIC
Entity type:Organization
Organization Name:DAT MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:
Authorized Official - Last Name:DARAMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-279-5526
Mailing Address - Street 1:12808 W AIRPORT BLVD
Mailing Address - Street 2:348
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-6184
Mailing Address - Country:US
Mailing Address - Phone:832-279-5526
Mailing Address - Fax:832-447-1093
Practice Address - Street 1:12808 W AIRPORT BLVD
Practice Address - Street 2:348
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-6184
Practice Address - Country:US
Practice Address - Phone:832-279-5526
Practice Address - Fax:832-447-1093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPHRAIM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center