| Valley Medical Clinic, Llc | |
|
17567 Imperial Valley Dr Houston TX 77060-6102 | |
| (281) 877-0187 | |
| (281) 877-0189 |
| Full Name | Valley Medical Clinic, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 17567 Imperial Valley Dr, Houston, Texas |
| Authorized Official Name and Position | Victor Osagie (PRESIDENT) |
| Authorized Official Contact | 2818770187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Valley Medical Clinic, Llc 17567 Imperial Valley Dr Houston TX 77060-6102 Ph: (281) 877-0187 | Valley Medical Clinic, Llc 17567 Imperial Valley Dr Houston TX 77060-6102 Ph: (281) 877-0187 |
| NPI Number | 1457645087 |
|---|---|
| Provider Enumeration Date | 05/31/2011 |
| Last Update Date | 01/13/2012 |
| Medicare PECOS PAC ID | 7810162864 |
|---|---|
| Medicare Enrollment ID | O20111202000587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457645087 | NPI | - | NPPES |
| TXB140907 | Other | TX | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Rosemary O Obudulu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740215029 PECOS PAC ID: 9830289776 Enrollment ID: I20071217000186 |
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