Healthcare Provider Details

I. General information

NPI: 1124242862
Provider Name (Legal Business Name): KUYKENDAHL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21301 KUYKENDAHL RD SUITE A
SPRING TX
77379-2611
US

IV. Provider business mailing address

PO BOX 840795
DALLAS TX
75284-0795
US

V. Phone/Fax

Practice location:
  • Phone: 281-803-1000
  • Fax: 972-899-5954
Mailing address:
  • Phone: 972-899-6650
  • Fax: 972-899-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number160010
License Number StateTX

VIII. Authorized Official

Name: TIM FIELDING
Title or Position: CFO
Credential:
Phone: 972-899-6650