Healthcare Provider Details

I. General information

NPI: 1922919836
Provider Name (Legal Business Name): FOUNTAINS OF THE WOODLANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17191 ST LUKES WAY STE 285
CONROE TX
77384-8042
US

IV. Provider business mailing address

17191 ST LUKES WAY STE 285
CONROE TX
77384-8042
US

V. Phone/Fax

Practice location:
  • Phone: 346-560-7080
  • Fax: 346-560-7081
Mailing address:
  • Phone: 346-560-7080
  • Fax: 346-560-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM HEGI
Title or Position: OWNER
Credential:
Phone: 346-560-7080