Provider Demographics
NPI:1871047738
Name:ANTOINE CLINIC
Entity type:Organization
Organization Name:ANTOINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-694-4300
Mailing Address - Street 1:7337 MCHENRY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-3632
Mailing Address - Country:US
Mailing Address - Phone:713-644-4442
Mailing Address - Fax:713-644-8964
Practice Address - Street 1:7337 MCHENRY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-3632
Practice Address - Country:US
Practice Address - Phone:713-644-4442
Practice Address - Fax:713-644-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9374207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD79646Medicare UPIN