Provider Demographics
NPI:1902980808
Name:UNIFIED MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:UNIFIED MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-772-1300
Mailing Address - Street 1:10101 HARWIN DR. STE. 260
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036
Mailing Address - Country:US
Mailing Address - Phone:713-772-1300
Mailing Address - Fax:713-772-1310
Practice Address - Street 1:10101 HARWIN DR
Practice Address - Street 2:SUITE 260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1687
Practice Address - Country:US
Practice Address - Phone:713-772-1300
Practice Address - Fax:713-772-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014109251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677995Medicare ID - Type UnspecifiedMEDICARE NUMBER