MEDICARE: PASADENA HEALTH CENTER, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)	M8383	TX
2	261QF0400X	Federally Qualified Health Center (FQHC)	21495	TX
3	261QF0400X	Federally Qualified Health Center (FQHC)	19719	TX
4	261QF0400X	Federally Qualified Health Center (FQHC)	M8570	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1932104965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASADENA HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	908 SOUTHMORE AVE.
Second Line	:	STE 100
City	:	PASADENA
State	:	TX
Zip	:	77502-1120
Country	:	US
Telephone Number	:	713-554-1091
Fax Number	:	713-554-1096

Provider Business Practice Location Address
First Line	:	908 SOUTHMORE AVE
Second Line	:	STE 100
City	:	PASADENA
State	:	TX
Zip	:	77502-1134
Country	:	US
Telephone Number	:	713-554-1091
Fax Number	:	713-554-1096

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOHN MICHAEL SWEITZER
Credential	:
Telephone Number	:	713-554-1091

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	05/07/2009

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Directions to “PASADENA HEALTH CENTER, INC ” Practice Location

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