Basic Information
| Provider Information | |||||||||
| NPI: | 1316005838 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL CENTER ASSOCIATES OF HOUSTON, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6624 FANNIN ST | ||||||||
| Address2: | SUITE 1730 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137908025 | ||||||||
| FaxNumber: | 7134269102 | ||||||||
| Practice Location | |||||||||
| Address1: | 6624 FANNIN ST | ||||||||
| Address2: | SUITE 1730 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137908025 | ||||||||
| FaxNumber: | 7137908096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 10/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | KAZIM | ||||||||
| AuthorizedOfficialFirstName: | LUBNA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7134269104 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 172559001 | 05 | TX | MEDICAID |