| South Belt Medical Clinic | |
|
10594 Fuqua St Houston TX 77089-1402 | |
| (281) 484-3500 | |
| (281) 484-3517 |
| Full Name | South Belt Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 10594 Fuqua St, Houston, Texas |
| Authorized Official Name and Position | Thandavarajan Gopalakrishnan (OWNER) |
| Authorized Official Contact | 2814843500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Belt Medical Clinic 10594 Fuqua St Houston TX 77089-1402 Ph: (281) 484-3500 | South Belt Medical Clinic 10594 Fuqua St Houston TX 77089-1402 Ph: (281) 484-3500 |
| NPI Number | 1316154073 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 07/26/2007 |
| Medicare PECOS PAC ID | 0547242232 |
|---|---|
| Medicare Enrollment ID | O20040605000251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316154073 | NPI | - | NPPES |
| 00506U | Other | TX | GROUP MC #T GOPAL & ASSOC |
| I04507 | Other | TX | MC UPIN DR. BALASUBRAMANI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | K5966 (Texas) | Primary |
| Provider Name | Thandavarajan Gopalakrishnan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194786137 PECOS PAC ID: 6305834789 Enrollment ID: I20070905000606 |
| Provider Name | Subhadra Bandhakavi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356383152 PECOS PAC ID: 8729136734 Enrollment ID: I20100928000864 |
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