Healthcare Provider Details

I. General information

NPI: 1912607227
Provider Name (Legal Business Name): DEDRIC K. MYERS & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10039 BISSONNET ST STE 307
HOUSTON TX
77036-7840
US

IV. Provider business mailing address

3 SUGAR CREEK CENTER BLVD STE 100
SUGAR LAND TX
77478-2211
US

V. Phone/Fax

Practice location:
  • Phone: 281-636-5309
  • Fax:
Mailing address:
  • Phone: 281-636-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEDRIC K. MYERS
Title or Position: OWNER
Credential: MT(ASCP)
Phone: 281-636-5309