Healthcare Provider Details

I. General information

NPI: 1891229399
Provider Name (Legal Business Name): SYNERGENX HEALTH - KINGWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 11/02/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 ROYAL FRST STE B-150
KINGWOOD TX
77339-5045
US

IV. Provider business mailing address

16131 N ELDRIDGE PKWY STE 100
TOMBALL TX
77377-9130
US

V. Phone/Fax

Practice location:
  • Phone: 832-899-5618
  • Fax:
Mailing address:
  • Phone: 281-429-8522
  • Fax: 281-970-5913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WELTON WAYNE WILSON
Title or Position: CEO
Credential:
Phone: 281-429-8522