Healthcare Provider Details

I. General information

NPI: 1831946078
Provider Name (Legal Business Name): TAVEL PALLIATIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 GRAPE ST
HOUSTON TX
77096-1114
US

IV. Provider business mailing address

5630 GRAPE ST
HOUSTON TX
77096-1114
US

V. Phone/Fax

Practice location:
  • Phone: 713-253-1142
  • Fax:
Mailing address:
  • Phone: 713-253-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA LEE TAVEL-MILLER
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 713-253-1142