| East Houston Physicians Group, Pa | |
|
11821 East Fwy Ste 175 Houston TX 77029-1960 | |
| (713) 330-0766 | |
| (877) 862-8370 |
| Full Name | East Houston Physicians Group, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 11821 East Fwy Ste 175, Houston, Texas |
| Authorized Official Name and Position | Ronald Wayne Killam (CEO) |
| Authorized Official Contact | 7133300766 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Houston Physicians Group, Pa Po Box 96706 Houston TX 77213-6706 Ph: (713) 330-0766 | East Houston Physicians Group, Pa 11821 East Fwy Ste 175 Houston TX 77029-1960 Ph: (713) 330-0766 |
| NPI Number | 1518219104 |
|---|---|
| Provider Enumeration Date | 10/08/2012 |
| Last Update Date | 06/27/2024 |
| Medicare PECOS PAC ID | 7719131614 |
|---|---|
| Medicare Enrollment ID | O20130130000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518219104 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Ronald W Killam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013960228 PECOS PAC ID: 0648212027 Enrollment ID: I20050525000986 |
| Provider Name | Luis J Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326284514 PECOS PAC ID: 0749337285 Enrollment ID: I20090420000527 |
| Provider Name | Hugh Prince |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578755799 PECOS PAC ID: 7517289366 Enrollment ID: I20141204002020 |
| Provider Name | Jessy M Mathew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942620588 PECOS PAC ID: 7810210085 Enrollment ID: I20141218001728 |
| Provider Name | Anitha K Allala-ettireddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225305121 PECOS PAC ID: 0547543456 Enrollment ID: I20170218000052 |
| Provider Name | Maria Eniola Agholor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871027649 PECOS PAC ID: 9537413083 Enrollment ID: I20181119003101 |
| Provider Name | Erin Michelle Ambrose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366983652 PECOS PAC ID: 1759620529 Enrollment ID: I20190222001932 |
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