| Gastroenterology Diagnostic Clinic, | |
|
5050 Crenshaw Rd #200 Pasadena TX 77505-3139 | |
| (281) 998-2488 | |
| (281) 998-2482 |
| Full Name | Gastroenterology Diagnostic Clinic, |
|---|---|
| Speciality | Internal Medicine |
| Location | 5050 Crenshaw Rd, Pasadena, Texas |
| Authorized Official Name and Position | Maurice S Haddad (OWNER/PHYSICIAN) |
| Authorized Official Contact | 2819982488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastroenterology Diagnostic Clinic, 5050 Crenshaw Rd #200 Pasadena TX 77505-3139 Ph: (281) 998-2488 | Gastroenterology Diagnostic Clinic, 5050 Crenshaw Rd #200 Pasadena TX 77505-3139 Ph: (281) 998-2488 |
| NPI Number | 1538158563 |
|---|---|
| Provider Enumeration Date | 10/21/2005 |
| Last Update Date | 10/15/2012 |
| Medicare PECOS PAC ID | 8426155409 |
|---|---|
| Medicare Enrollment ID | O20101027001501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538158563 | NPI | - | NPPES |
| 094050401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Lizbeth Santana-blaise |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558672931 PECOS PAC ID: 3678606480 Enrollment ID: I20100730000462 |
| Provider Name | Maurice Sadik Haddad |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1174512131 PECOS PAC ID: 5890878706 Enrollment ID: I20110713000147 |
| Provider Name | Joyce Marie Shedrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750866414 PECOS PAC ID: 9436491735 Enrollment ID: I20190507003002 |
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