| East Houston Medicine & Pediatrics Clinic Pa | |
|
902 Normandy St Ste 100 Houston TX 77015-4952 | |
| (713) 450-4455 | |
| (713) 450-4737 |
| Full Name | East Houston Medicine & Pediatrics Clinic Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 902 Normandy St, Houston, Texas |
| Authorized Official Name and Position | Cornelius Antoinne Wilson (OWNER PRESIDENT) |
| Authorized Official Contact | 7134504455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Houston Medicine & Pediatrics Clinic Pa Po Box 24308 Houston TX 77229-4308 Ph: (713) 450-4455 | East Houston Medicine & Pediatrics Clinic Pa 902 Normandy St Ste 100 Houston TX 77015-4952 Ph: (713) 450-4455 |
| NPI Number | 1083686091 |
|---|---|
| Provider Enumeration Date | 02/03/2006 |
| Last Update Date | 07/20/2017 |
| Medicare PECOS PAC ID | 0941260095 |
|---|---|
| Medicare Enrollment ID | O20041013001164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083686091 | NPI | - | NPPES |
| 0081QD | Other | TX | BLUE CROSS |
| 00L66J | Other | TX | BCBS |
| 184593501 | Medicaid | TX | |
| 45D1000292 | Other | TX | CLIA |
| 184593502 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RA0000X | Internal Medicine - Adolescent Medicine | J2845 (Texas) | Primary |
| Provider Name | Cornelius A Wilson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215032586 PECOS PAC ID: 1759360837 Enrollment ID: I20040714000753 |
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