Healthcare Provider Details

I. General information

NPI: 1093218950
Provider Name (Legal Business Name): 105 EXPRESS CARE OF CONROE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 W DAVIS ST STE I
CONROE TX
77304-1845
US

IV. Provider business mailing address

3708 W DAVIS ST STE I
CONROE TX
77304-1845
US

V. Phone/Fax

Practice location:
  • Phone: 936-441-2021
  • Fax:
Mailing address:
  • Phone: 936-441-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberL2349
License Number StateTX

VIII. Authorized Official

Name: NADEEM JAMIL
Title or Position: OWNER
Credential: MD
Phone: 832-844-3746