| NPI | 1285409417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN TARASENKO Strategic Development Director 281-540-0063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2026-07-24 |