Basic Information
| Provider Information | |||||||||
| NPI: | 1023274529 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST CLINICAL RESEARCH ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 542210 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772542210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138241172 | ||||||||
| FaxNumber: | 7137900616 | ||||||||
| Practice Location | |||||||||
| Address1: | 7900 FANNIN ST. SUITE 2700 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138241172 | ||||||||
| FaxNumber: | 7137900600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | HAAS | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7138241172 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.