Healthcare Provider Details

I. General information

NPI: 1215718333
Provider Name (Legal Business Name): PHOENIX MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 E MOSSY OAKS RD STE 480
SPRING TX
77389-1813
US

IV. Provider business mailing address

2255 E MOSSY OAKS RD STE 480
SPRING TX
77389-1813
US

V. Phone/Fax

Practice location:
  • Phone: 954-263-1424
  • Fax:
Mailing address:
  • Phone: 954-263-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY MICHELLE PATTERSON
Title or Position: DIRECTOR
Credential: MD
Phone: 954-263-1424