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320 Kingwood Executive Dr Ste E Kingwood TX 77339 | |
| (281) 359-5981 | |
| (281) 359-3591 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 320 Kingwood Executive Dr, Kingwood, Texas |
| Authorized Official Name and Position | Wendell Grogan (PRESIDENT) |
| Authorized Official Contact | 2813595981 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 9547 Belfast ME 04915-9547 Ph: (281) 359-5981 | 320 Kingwood Executive Dr Ste E Kingwood TX 77339 Ph: (281) 359-5981 |
| NPI Number | 1457541237 |
|---|---|
| Provider Enumeration Date | 07/27/2007 |
| Last Update Date | 09/09/2024 |
| Certification Date | 09/03/2024 |
| Medicare PECOS PAC ID | 9436105863 |
|---|---|
| Medicare Enrollment ID | O20050329000295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457541237 | NPI | - | NPPES |
| 172034401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Dewey Le |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447454012 PECOS PAC ID: 1557451549 Enrollment ID: I20071213000749 |
| Provider Name | Uzma Ali |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1235337254 PECOS PAC ID: 6103927496 Enrollment ID: I20110506000647 |
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