MEDICARE: SCARBOROUGH FAMILY MEDICINE, PLLC

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	H8380	TX

General Provider Information

NPI Number	:	1679997530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCARBOROUGH FAMILY MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 2727
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77305-2727
Country	:	US
Telephone Number	:	713-396-3900
Fax Number	:	936-760-4639

Provider Business Practice Location Address
First Line	:	508 MEDICAL CENTER BLVD
Second Line	:	SUITE 350
City	:	CONROE
State	:	TX
Zip	:	77304-2953
Country	:	US
Telephone Number	:	713-396-3900
Fax Number	:	936-760-4639

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JUDY MCFARLAND
Credential	:	CPCS
Telephone Number	:	713-396-3900

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	02/13/2014

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