Healthcare Provider Details

I. General information

NPI: 1093216632
Provider Name (Legal Business Name): CENTRAL HOUSTON MANAGEMENT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 SOUTHWEST FWY STE 230
HOUSTON TX
77027-7327
US

IV. Provider business mailing address

10507 E WILDWIND CIR
SPRING TX
77380-4043
US

V. Phone/Fax

Practice location:
  • Phone: 713-562-7890
  • Fax: 281-605-4566
Mailing address:
  • Phone: 281-543-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberK8150
License Number StateTX

VIII. Authorized Official

Name: MARK FILLEY
Title or Position: MANAGER
Credential: MD
Phone: 281-543-0012