Provider Demographics
NPI:1861404691
Name:PRE MED CARE CLINIC, LLC
Entity type:Organization
Organization Name:PRE MED CARE CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:936-258-9361
Mailing Address - Street 1:5420 BELLAIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3957
Mailing Address - Country:US
Mailing Address - Phone:713-663-6322
Mailing Address - Fax:713-663-6944
Practice Address - Street 1:5420 BELLAIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3957
Practice Address - Country:US
Practice Address - Phone:713-663-6322
Practice Address - Fax:713-663-6944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0079EMOtherBCBS
TX169667603Medicaid
TX0079EMOtherBCBS