| Eagle's Trace Medical Center | |
|
14703 Eagle Vista Dr Houston TX 77077-5275 | |
| (281) 249-7100 | |
| (281) 249-7365 |
| Full Name | Eagle's Trace Medical Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 14703 Eagle Vista Dr, Houston, Texas |
| Authorized Official Name and Position | Mary Norman (PRESIDENT) |
| Authorized Official Contact | 4104022257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle's Trace Medical Center 5730 Executive Dr Ste 230 Catonsville MD 21228-1762 Ph: (281) 249-7100 | Eagle's Trace Medical Center 14703 Eagle Vista Dr Houston TX 77077-5275 Ph: (281) 249-7100 |
| NPI Number | 1285654079 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 12/08/2022 |
| Medicare PECOS PAC ID | 1951316017 |
|---|---|
| Medicare Enrollment ID | O20060209000683 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285654079 | NPI | - | NPPES |
| 0089EP | Other | BCBS - FEATHERSTON | |
| 8AS969 | Other | BCBS - FEATHERSTON | |
| 0093NP | Other | BCBS OF TX |
| Provider Name | Raina Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144224544 PECOS PAC ID: 0547165144 Enrollment ID: I20031205000598 |
| Provider Name | Kellie L Kahveci |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316968225 PECOS PAC ID: 3274435326 Enrollment ID: I20040121000349 |
| Provider Name | Aparna R Kotamarti |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1992735609 PECOS PAC ID: 9032125356 Enrollment ID: I20060223000629 |
| Provider Name | Brian N Tremaine |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205897147 PECOS PAC ID: 3779599824 Enrollment ID: I20060227000303 |
| Provider Name | Jill Louise Studley |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1023049053 PECOS PAC ID: 2062513153 Enrollment ID: I20070719000192 |
| Provider Name | Mahenaaz Haq |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922275098 PECOS PAC ID: 1355419813 Enrollment ID: I20081010000182 |
| Provider Name | Vivianne Nguyen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1982863833 PECOS PAC ID: 6800933755 Enrollment ID: I20091026000126 |
| Provider Name | Jane L Champion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780955393 PECOS PAC ID: 6800056904 Enrollment ID: I20120328000041 |
| Provider Name | Nagaleela M Chandra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265696306 PECOS PAC ID: 4688811821 Enrollment ID: I20140919000196 |
| Provider Name | Cynthia T Kieu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396978532 PECOS PAC ID: 4486700309 Enrollment ID: I20151203002874 |
| Provider Name | Patricia J Dickson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508365388 PECOS PAC ID: 6204199235 Enrollment ID: I20180404001538 |
| Provider Name | Faiza Khan |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1154766723 PECOS PAC ID: 2062774011 Enrollment ID: I20180503001652 |
| Provider Name | John Marcelis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285667105 PECOS PAC ID: 4082753355 Enrollment ID: I20201028001509 |
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