| Broadway Medical Clinic, P.a. | |
|
3208 Broadway St Houston TX 77017-2321 | |
| (713) 641-5656 | |
| (713) 641-5293 |
| Full Name | Broadway Medical Clinic, P.a. |
|---|---|
| Speciality | Clinic/center |
| Location | 3208 Broadway St, Houston, Texas |
| Authorized Official Name and Position | J. Felipe Nieto (PRESIDENT/MEDICAL DIRECTOR) |
| Authorized Official Contact | 7136415656 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Medical Clinic, P.a. 3208 Broadway St Houston TX 77017-2321 Ph: (713) 641-5656 | Broadway Medical Clinic, P.a. 3208 Broadway St Houston TX 77017-2321 Ph: (713) 641-5656 |
| NPI Number | 1295830990 |
|---|---|
| Provider Enumeration Date | 09/14/2006 |
| Last Update Date | 11/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295830990 | NPI | - | NPPES |
| 092059701 | Medicaid | TX | |
| 900013387001 | Other | TX | APS HEALTHCARE |
| 10004520 | Other | TX | AMERIGROUP |
| 10020679 | Other | TX | AMERIGROUP |
| 000000U92M | Other | TX | BC BS |
| 092059702 | Medicaid | TX | |
| 133829501 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | F7365 (Texas) | Primary |
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