| Midtown Clinical Assoc, Pa | |
|
4405 Griggs Rd Houston TX 77021-2815 | |
| (713) 748-4662 | |
| Not Available |
| Full Name | Midtown Clinical Assoc, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 4405 Griggs Rd, Houston, Texas |
| Authorized Official Name and Position | Endia Nichelle Walls (OWNER) |
| Authorized Official Contact | 7137484662 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midtown Clinical Assoc, Pa Po Box 300958 Houston TX 77230-0958 Ph: () - | Midtown Clinical Assoc, Pa 4405 Griggs Rd Houston TX 77021-2815 Ph: (713) 748-4662 |
| NPI Number | 1760600217 |
|---|---|
| Provider Enumeration Date | 04/22/2007 |
| Last Update Date | 11/02/2022 |
| Medicare PECOS PAC ID | 9739077595 |
|---|---|
| Medicare Enrollment ID | O20040304001186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760600217 | NPI | - | NPPES |
| 163278801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Endia Walls |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295843621 PECOS PAC ID: 0749178515 Enrollment ID: I20040304001262 |
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