| Jose Mayen Md Pa | |
|
561 W Medical Center Blvd Suite C Webster TX 77598-4239 | |
| (281) 332-1075 | |
| (281) 332-7012 |
| Full Name | Jose Mayen Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 561 W Medical Center Blvd, Webster, Texas |
| Authorized Official Name and Position | Jose I Mayen Nunez (PRESIDENT) |
| Authorized Official Contact | 2813321075 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jose Mayen Md Pa 561 W Medical Center Blvd Suite C Webster TX 77598-4239 Ph: (281) 332-1075 | Jose Mayen Md Pa 561 W Medical Center Blvd Suite C Webster TX 77598-4239 Ph: (281) 332-1075 |
| NPI Number | 1760872675 |
|---|---|
| Provider Enumeration Date | 01/29/2015 |
| Last Update Date | 01/29/2015 |
| Medicare PECOS PAC ID | 9931531837 |
|---|---|
| Medicare Enrollment ID | O20191114001814 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760872675 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Jose Mayen Nunez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407879489 PECOS PAC ID: 9133258890 Enrollment ID: I20100519000221 |
| Provider Name | Gohnesh Tesfaye Legesse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346592342 PECOS PAC ID: 6204253446 Enrollment ID: I20200902000896 |
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