| East End Medical Clinic | |
|
906 Wayside Dr Houston TX 77011-2518 | |
| (713) 923-6627 | |
| (713) 923-9383 |
| Full Name | East End Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 906 Wayside Dr, Houston, Texas |
| Authorized Official Name and Position | Chandralatha Thota (MEDICAL OFFICER) |
| Authorized Official Contact | 7139236627 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East End Medical Clinic 906 Wayside Dr Houston TX 77011-2518 Ph: (713) 923-6627 | East End Medical Clinic 906 Wayside Dr Houston TX 77011-2518 Ph: (713) 923-6627 |
| NPI Number | 1235372467 |
|---|---|
| Provider Enumeration Date | 04/17/2009 |
| Last Update Date | 10/02/2014 |
| Medicare PECOS PAC ID | 8325192321 |
|---|---|
| Medicare Enrollment ID | O20090810000509 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235372467 | NPI | - | NPPES |
| 214554202 | Medicaid | TX | |
| 082252001 | Medicaid | TX | |
| 214554201 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Chandralatha Thota |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386735348 PECOS PAC ID: 8729078365 Enrollment ID: I20090817000359 |
| Provider Name | Laura Ucheonye Umez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578985024 PECOS PAC ID: 1456685247 Enrollment ID: I20190627002936 |
| Provider Name | Imelda Diala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437556313 PECOS PAC ID: 6800884511 Enrollment ID: I20190729000275 |
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