Healthcare Provider Details

I. General information

NPI: 1902442056
Provider Name (Legal Business Name): LONE STAR COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 12/20/2021
Certification Date: 12/16/2021
Deactivation Date: 01/17/2020
Reactivation Date: 11/05/2021

III. Provider practice location address

227 SH 75N STE. 130
HUNTSVILLE TX
77320-3171
US

IV. Provider business mailing address

605 S CONROE MEDICAL DR
CONROE TX
77304-4722
US

V. Phone/Fax

Practice location:
  • Phone: 936-539-4004
  • Fax: 936-291-0746
Mailing address:
  • Phone: 936-539-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KAREN HARWELL
Title or Position: CEO
Credential:
Phone: 936-539-4004