MEDICARE: CENTER FOR FAMILY & PREVENTIVE MEDICINE, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E1466, AND K9887	TX

General Provider Information

NPI Number	:	1265516306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR FAMILY & PREVENTIVE MEDICINE, PA

Provider Business Mailing Address
First Line	:	14700 FM 2100 RD STE A
Second Line	:
City	:	CROSBY
State	:	TX
Zip	:	77532-9161
Country	:	US
Telephone Number	:	281-328-2568
Fax Number	:	281-328-2039

Provider Business Practice Location Address
First Line	:	14700 FM 2100 RD STE A
Second Line	:
City	:	CROSBY
State	:	TX
Zip	:	77532-9161
Country	:	US
Telephone Number	:	281-328-2568
Fax Number	:	281-328-2039

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUDSON S HENDERSON
Credential	:	M.D.
Telephone Number	:	281-328-2568

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/22/2020

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