Healthcare Provider Details

I. General information

NPI: 1114126612
Provider Name (Legal Business Name): DEWITT MEDICAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 WILL CLAYTON PKWY
HUMBLE TX
77338-5830
US

IV. Provider business mailing address

8450 WILL CLAYTON PKWY
HUMBLE TX
77338-5830
US

V. Phone/Fax

Practice location:
  • Phone: 281-446-8484
  • Fax: 281-446-0386
Mailing address:
  • Phone: 281-446-8484
  • Fax: 281-446-0386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number118580
License Number StateTX

VIII. Authorized Official

Name: ALMA ALEXANDER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 361-275-6191