Healthcare Provider Details

I. General information

NPI: 1730590761
Provider Name (Legal Business Name): INCLUSIVE HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 MAPLERIDGE ST # 115
HOUSTON TX
77081-4600
US

IV. Provider business mailing address

6550 MAPLERIDGE ST #117
HOUSTON TX
77081-4600
US

V. Phone/Fax

Practice location:
  • Phone: 832-649-7919
  • Fax: 888-812-4235
Mailing address:
  • Phone: 832-649-7919
  • Fax: 888-812-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number801859664
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number801859664
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number801859664
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number801859664
License Number StateTX

VIII. Authorized Official

Name: DAMEON TRYON
Title or Position: OPERATIONS OFFICER
Credential:
Phone: 832-946-7919