Provider Demographics
NPI:1679710354
Name:C. MEDRANO MD PLLC
Entity type:Organization
Organization Name:C. MEDRANO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION VP/AO
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORDONOWY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-218-1762
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4525
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:866-346-1426
Practice Address - Street 1:7400 FANNIN ST
Practice Address - Street 2:SUITE 800
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1920
Practice Address - Country:US
Practice Address - Phone:713-797-1100
Practice Address - Fax:713-797-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204605001Medicaid
TX204605001Medicaid