| Katy Supportive Medicine, P.a. | |
|
205 Bella Katy Dr Katy TX 77494-6821 | |
| (281) 665-4032 | |
| (281) 665-1206 |
| Full Name | Katy Supportive Medicine, P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 205 Bella Katy Dr, Katy, Texas |
| Authorized Official Name and Position | Sandra Perez (OFFICE MANAGER) |
| Authorized Official Contact | 2816654032 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Katy Supportive Medicine, P.a. 21700 Bellaire Blvd Richmond TX 77407-3906 Ph: (281) 599-0300 | Katy Supportive Medicine, P.a. 205 Bella Katy Dr Katy TX 77494-6821 Ph: (281) 665-4032 |
| NPI Number | 1346645066 |
|---|---|
| Provider Enumeration Date | 10/23/2014 |
| Last Update Date | 08/02/2022 |
| Medicare PECOS PAC ID | 6901121532 |
|---|---|
| Medicare Enrollment ID | O20150202001897 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346645066 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | N6844 (Texas) | Primary |
| 207RH0002X | Internal Medicine - Hospice And Palliative Medicine | N6844 (Texas) | Secondary |
| Provider Name | Tonya R Maxwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144277500 PECOS PAC ID: 0446253496 Enrollment ID: I20060814000299 |
| Provider Name | Gail E Donley-urita |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1699810390 PECOS PAC ID: 5991734576 Enrollment ID: I20101124000459 |
| Provider Name | Staci Michelle Larkin |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1295242402 PECOS PAC ID: 1850715137 Enrollment ID: I20200721000384 |
| Provider Name | Shaunna M Caouette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275178675 PECOS PAC ID: 1355758970 Enrollment ID: I20210330000729 |
| Provider Name | Ngozi Gladys Kalu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437342250 PECOS PAC ID: 0840689303 Enrollment ID: I20211123000458 |
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