| League City Family Clinic, Pllc | |
|
1507 West League City Parkway Suite 200 League City TX 77573-6768 | |
| (281) 525-6290 | |
| (832) 905-6173 |
| Full Name | League City Family Clinic, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1507 West League City Parkway, League City, Texas |
| Authorized Official Name and Position | Hanan Hussein (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2815256290 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| League City Family Clinic, Pllc 1507 West League City Parkway Suite 200 League City TX 77573-6768 Ph: (281) 525-6290 | League City Family Clinic, Pllc 1507 West League City Parkway Suite 200 League City TX 77573-6768 Ph: (281) 525-6290 |
| NPI Number | 1700247079 |
|---|---|
| Provider Enumeration Date | 03/15/2016 |
| Last Update Date | 04/11/2017 |
| Medicare PECOS PAC ID | 8123319241 |
|---|---|
| Medicare Enrollment ID | O20160621001811 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700247079 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M9365 (Texas) | Primary |
| Provider Name | Hanan Hussein |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871786566 PECOS PAC ID: 7012001431 Enrollment ID: I20070917000214 |
| Provider Name | Carlie Cooksey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316551823 PECOS PAC ID: 0143629832 Enrollment ID: I20210601000275 |
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