Cleveland Medical Clinic Family

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

F4703 Issued in TX

Legal business name

CLEVELAND MEDICAL CLINIC FAMILY

Practice address

208 N Bonham Ave
Cleveland, TX 77327-4023

Phone

(281) 592-3600

NPI assigned

Oct 27, 2006

Last updated

Feb 2, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Philip R Wisiackas, MD

Title

Physician

Phone

(281) 592-3600

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265068800000",
    "number": "1437235116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 N BONHAM AVE",
            "city": "CLEVELAND",
            "state": "TX",
            "postal_code": "773274023",
            "telephone_number": "281-592-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 N BONHAM AVE",
            "city": "CLEVELAND",
            "state": "TX",
            "postal_code": "773274023",
            "telephone_number": "281-592-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEVELAND MEDICAL CLINIC FAMILY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2010-02-02",
        "status": "A",
        "authorized_official_last_name": "WISIACKAS",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "281-592-3600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "F4703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126965602",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cleveland Diagnostic Center PA
• Cleveland Emergency Group PA
• Cleveland General Hospital LLC
• Cleveland Imaging and Surgical Hospital, L.L.C. (Doctor's Diagnostic Hospital)
• Cleveland Independent School District
• Cleveland Pediatric Clinic
• Cleveland Physical Therapy LTD
• Cleveland Physical Therapy LTD.
• Cleveland Physician Services P a
• Cleveland Physician Services PLLC

• Physician Assistant in Cleveland, TX
• Providers in Cleveland, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.