Provider Demographics
NPI:1902101736
Name:SPO FAMILY CARE MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:SPO FAMILY CARE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:AHAIWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-562-3195
Mailing Address - Street 1:14215 S POST OAK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-5233
Mailing Address - Country:US
Mailing Address - Phone:713-433-4536
Mailing Address - Fax:713-433-6708
Practice Address - Street 1:14215 S POST OAK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5233
Practice Address - Country:US
Practice Address - Phone:713-433-4536
Practice Address - Fax:713-433-6708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4168208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty