| Space Center Primary Care, Pllc | |
|
907 Bay Area Blvd Ste B Houston TX 77058-2665 | |
| (281) 286-6000 | |
| (281) 488-8686 |
| Full Name | Space Center Primary Care, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 907 Bay Area Blvd Ste B, Houston, Texas |
| Authorized Official Name and Position | Deran Y Wong (PHYSICIAN) |
| Authorized Official Contact | 2812866000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Space Center Primary Care, Pllc 907 Bay Area Blvd Ste B Houston TX 77058-2665 Ph: (281) 286-6000 | Space Center Primary Care, Pllc 907 Bay Area Blvd Ste B Houston TX 77058-2665 Ph: (281) 286-6000 |
| NPI Number | 1033661715 |
|---|---|
| Provider Enumeration Date | 10/28/2016 |
| Last Update Date | 11/28/2016 |
| Medicare PECOS PAC ID | 2264713924 |
|---|---|
| Medicare Enrollment ID | O20170111003239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033661715 | NPI | - | NPPES |
| 454495ZRZ | Other | TX | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | Q4875 (Texas) | Primary |
| Provider Name | Deran Yu-wei Wong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194089722 PECOS PAC ID: 4385954155 Enrollment ID: I20151124001349 |
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