| Greater Gulf Health Plan, Llc | |
|
260 N Sam Houston Pkwy E Ste 220 Houston TX 77060-2022 | |
| (281) 447-6800 | |
| (281) 447-6802 |
| Full Name | Greater Gulf Health Plan, Llc |
|---|---|
| Speciality | General Practice |
| Location | 260 N Sam Houston Pkwy E Ste 220, Houston, Texas |
| Authorized Official Name and Position | Lawrence J Wedekind (PRESIDENT) |
| Authorized Official Contact | 2814476800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greater Gulf Health Plan, Llc 260 N Sam Houston Pkwy E Suite 220 Houston TX 77060-2018 Ph: (281) 447-6800 | Greater Gulf Health Plan, Llc 260 N Sam Houston Pkwy E Ste 220 Houston TX 77060-2022 Ph: (281) 447-6800 |
| NPI Number | 1457574006 |
|---|---|
| Provider Enumeration Date | 04/11/2007 |
| Last Update Date | 06/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457574006 | NPI | - | NPPES |
| 176768301 | Medicaid | TX | |
| 176768302 | Medicaid | TX | |
| 00690K | Other | TX | BCBS ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 01486663 (Texas) | Primary |
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