MEDICARE: 1960 FAMILY PRACTICE 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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C16759	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760438840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1960 FAMILY PRACTICE PA

Provider Business Mailing Address
First Line	:	PO BOX 4356
Second Line	:	DEPARTMENT 667
City	:	HOUSTON
State	:	TX
Zip	:	77210-4356
Country	:	US
Telephone Number	:	281-586-3888
Fax Number	:	281-440-2020

Provider Business Practice Location Address
First Line	:	837 CYPRESS CREEK PKWY
Second Line	:	SUITE 105
City	:	HOUSTON
State	:	TX
Zip	:	77090-3423
Country	:	US
Telephone Number	:	281-586-3888
Fax Number	:	281-440-2020

Authorized Official
Title or Position	:	CREDENTIALING DEPARTMENT
Name	:	ANA BORJA
Credential	:
Telephone Number	:	281-453-7017

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/14/2013

Similar Medicare Providers

1215391941 — 1960 PHYSICIAN ASSOCIATES
Practice Location Address:

837 CYPRESS CREEK PKWY , SUITE 105
HOUSTON, TX
77090-3423

Practice Phone: 281-453-2585
Practice Fax: 281-440-2020

1700873262 — DR. HARI KRISHNA SUSARLA M.D.
Practice Location Address:

837 FM 1960 RD W , SUITE 105
HOUSTON, TX
77090-3423

Practice Phone: 281-586-3888
Practice Fax: 281-440-2020

1861431934 — DR. ANTHONY ANDREW YEE-YOUNG M.D.
Practice Location Address:

837 FM 1960 RD W , SUITE 105
HOUSTON, TX
77090-3423

Practice Phone: 281-586-3888
Practice Fax: 281-440-2020

1528001930 — ALEXANDER LU NGUYEN MD
Practice Location Address:

837 FM 1960 RD W , STE 105
HOUSTON, TX
77090-3423

Practice Phone: 281-586-3888
Practice Fax: 281-440-2020

1982715736 — DR. DANIEL PAUL ROZNOWSKI PHD, LCSW
Practice Location Address:

837 FM 1960 RD, WEST , SUITE 101
HOUSTON, TX
77090-3423

Practice Phone: 281-702-0404
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1801955893 — TAMI BERCKENHOFF PA
Practice Location Address:

837 FM 1960 RD W , SUITE 105
HOUSTON, TX
77090-3423

Practice Phone: 281-586-3888
Practice Fax: 281-440-2020

Directions to “1960 FAMILY PRACTICE PA ” Practice Location

Language	Start Address	Practice Location

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