| |
18842 S Memorial Dr Ste 120 Humble TX 77338-4229 | |
(281) 570-2525 | |
(832) 644-9596 |
Full Name | |
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Speciality | Clinic/Center |
Location | 18842 S Memorial Dr Ste 120, Humble, Texas |
Authorized Official Name and Position | Tequila Henderson (REVENUE CYCLE DIRECTOR) |
Authorized Official Contact | 7134260027 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2150 W. 18th Street Suite 300 Houston TX 77008 Ph: (713) 426-0027 | 18842 S Memorial Dr Ste 120 Humble TX 77338-4229 Ph: (281) 570-2525 |
NPI Number | 1154817450 |
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Provider Enumeration Date | 07/10/2018 |
Last Update Date | 10/24/2024 |
Medicare PECOS PAC ID | 6608977095 |
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Medicare Enrollment ID | O20190207002540 |
Identifier | Type | State | Issuer |
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1154817450 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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