Mt Houston Medical Clinic

Primary specialty

SpecialistTaxonomy code 174400000X

License

J8017 Issued in TX

Legal business name

MT HOUSTON MEDICAL CLINIC

Doing business as

Hui Jun Park, DC PC

Practice address

11703A Eastex Fwy
Houston, TX 77039-6205

Phone

(832) 683-4132

Fax

(832) 683-4133

NPI assigned

Apr 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Sandra Ann Shirah, ADMINISTRATOR

Title

Admin/Credentialing Supervisor

Phone

(832) 683-4132

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Hui Jun Park, DC PC Doing business as
• Mt Houston Medical Clinic Other name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John D Kirkwood, DO

  • Family Medicine Physician
  • Pasadena, TX
  • NPI 1073598777
  Medicare reassignment NPD
• Hui Jun Park, DC PC

  • Family Nurse Practitioner
  • Katy, TX
  • NPI 1619045937
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1346363587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11703A EASTEX FWY",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770396205",
            "telephone_number": "832-683-4132",
            "fax_number": "832-683-4133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11703A EASTEX FWY",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770396205",
            "telephone_number": "832-683-4132",
            "fax_number": "832-683-4133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT HOUSTON MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2019-10-03",
        "status": "A",
        "authorized_official_last_name": "SHIRAH",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMIN/CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "832-683-4132",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "J8017",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP126718",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GRP ID",
            "identifier": "0078GF",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hui Jun Park, DC PC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mt Houston Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Specialist in Houston, TX
• Providers in Houston, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.