Organization
BROADWAY MEDICAL CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. J. FELIPE NIETO M.D. (PRESIDENT/MEDICAL DIRECTOR)
(713) 641-5656
Entity
Organization
Contact information
Practice address
3208 BROADWAY ST, HOUSTON, TX 77017-2321
(713) 641-5656
(713) 641-5293
Mailing address
3208 BROADWAY ST, HOUSTON, TX 77017-2321
(713) 641-5656
(713) 641-5293
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
F7365
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000U92M
BC BS
TX
05
—
092059701
—
TX
05
—
092059702
—
TX
01
—
10004520
AMERIGROUP
TX
01
—
10020679
AMERIGROUP
TX
05
—
133829501
—
TX
01
—
900013387001
APS HEALTHCARE
TX
Enumeration date
09/14/2006
Last updated
11/02/2010
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