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19455 Stokes Rd Rm 605 Waller TX 77484-7310 | |
(979) 977-6395 | |
(979) 731-4570 |
Full Name | |
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Speciality | Clinic/Center |
Location | 19455 Stokes Rd, Waller, Texas |
Authorized Official Name and Position | Theresa Sabella (CEO) |
Authorized Official Contact | 9793832348 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1500 University Dr E Ste 100 College Station TX 77840-2600 Ph: (979) 383-2340 | 19455 Stokes Rd Rm 605 Waller TX 77484-7310 Ph: (979) 977-6395 |
NPI Number | 1134801566 |
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Provider Enumeration Date | 08/04/2023 |
Last Update Date | 07/10/2024 |
Medicare PECOS PAC ID | 4284542127 |
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Medicare Enrollment ID | O20240531001865 |
Identifier | Type | State | Issuer |
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1134801566 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Tomagwa Ministries, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1613 Key Street, Waller, TX 77484 Phone: 281-357-0747 Fax: 832-559-5190 |