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135 Oyster Creek Dr Ste B Lake Jackson TX 77566-4119 | |
| (979) 215-2309 | |
| (844) 272-3168 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 135 Oyster Creek Dr Ste B, Lake Jackson, Texas |
| Authorized Official Name and Position | Angela Nicole Blanks (CEO/ FNP) |
| Authorized Official Contact | 9792152309 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
135 Oyster Creek Dr Ste B Lake Jackson TX 77566-4119 Ph: (979) 215-2309 | 135 Oyster Creek Dr Ste B Lake Jackson TX 77566-4119 Ph: (979) 215-2309 |
| NPI Number | 1881166791 |
|---|---|
| Provider Enumeration Date | 12/18/2018 |
| Last Update Date | 09/25/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881166791 | NPI | - | NPPES |
| 1396703310 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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