Healthcare Provider Details

I. General information

NPI: 1831510510
Provider Name (Legal Business Name): 1488 URGENT CARE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FM 1488 RD STE. 200
CONROE TX
77384-3817
US

IV. Provider business mailing address

3600 FM 1488 RD STE. 200
CONROE TX
77384-3817
US

V. Phone/Fax

Practice location:
  • Phone: 718-480-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN PRUDHOMME
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 713-785-1119