MEDICARE: GLO FAMILY CARE CLINIC LLC

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

General Provider Information

NPI Number	:	1720681851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLO FAMILY CARE CLINIC LLC

Provider Business Mailing Address
First Line	:	7427 CHATHAN GLEN LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3849
Country	:	US
Telephone Number	:	832-400-2944
Fax Number	:

Provider Business Practice Location Address
First Line	:	7427 CHATHAN GLEN LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3849
Country	:	US
Telephone Number	:	832-400-2944
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. GLORIA IJIE
Credential	:	NP
Telephone Number	:	832-400-2944

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	09/11/2024

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