| 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 |