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4009 Bellaire Blvd Suite K Houston TX 77025-1169 | |
| (713) 661-6262 | |
| (713) 661-6611 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 4009 Bellaire Blvd, Houston, Texas |
| Authorized Official Name and Position | Rosie Medina (RN) |
| Authorized Official Contact | 7136616262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4009 Bellaire Blvd Ste K Houston TX 77025-1169 Ph: (713) 661-6262 | 4009 Bellaire Blvd Suite K Houston TX 77025-1169 Ph: (713) 661-6262 |
| NPI Number | 1740451830 |
|---|---|
| Provider Enumeration Date | 03/17/2008 |
| Last Update Date | 02/20/2023 |
| Medicare PECOS PAC ID | 2961681093 |
|---|---|
| Medicare Enrollment ID | O20110121000536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740451830 | NPI | - | NPPES |
| 0024RP | Other | TX | BLUE CROSS BLUE SHIELD |
| 45D0490645 | Other | TX | CLIA |
| CS3658 | Other | TX | MEDICARE - RAILROAD |
| 085720301 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208600000X | Surgery | (* (Not Available)) | Secondary |
| Provider Name | Younan Nowzaradan |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1861477150 PECOS PAC ID: 6103896428 Enrollment ID: I20040727001334 |
| Provider Name | Robert Carl Dillard |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1699157792 PECOS PAC ID: 4587083662 Enrollment ID: I20211019000634 |
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