NPI | 1144905415 |
---|---|
Doing Business As | MYCHN LAKEJACKSON |
Doing Business As | MYCHN LAKE JACKSON |
Entity Type | Organization |
Authorized Contact | COURTNEY GAINES Credentialing COO Rdinator Ii 281-824-1480 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 261Q00000X Clinic/Center |
261QM1300X Clinic/Center, Multi-Specialty | |
Enumeration Date | 2023-06-15 |
Last Update Date | 2025-03-06 |