Provider Demographics
NPI:1144425703
Name:MEDICAL SCREENING CLINIC, INC.
Entity type:Organization
Organization Name:MEDICAL SCREENING CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:D
Authorized Official - Last Name:STOCKDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-944-9830
Mailing Address - Street 1:3350 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1904
Mailing Address - Country:US
Mailing Address - Phone:713-944-9830
Mailing Address - Fax:713-944-6116
Practice Address - Street 1:3350 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1904
Practice Address - Country:US
Practice Address - Phone:713-944-9830
Practice Address - Fax:713-944-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00BT94Medicare PIN