Healthcare Provider Details

I. General information

NPI: 1932507175
Provider Name (Legal Business Name): COLLEGE PARK HOME VISITS MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 COLLEGE PARK DR SUITE 106
CONROE TX
77384-4000
US

IV. Provider business mailing address

1515 HERITAGE DR STE 110
MCKINNEY TX
75069-3379
US

V. Phone/Fax

Practice location:
  • Phone: 936-441-1230
  • Fax:
Mailing address:
  • Phone: 855-860-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL2005
License Number StateTX

VIII. Authorized Official

Name: SAMSON SHEIH
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 936-788-1177