Healthcare Provider Details

I. General information

NPI: 1861768483
Provider Name (Legal Business Name): CARING PROFESSIONAL ACO GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 GRAHAM DR SUITE 200
TOMBALL TX
77375-3346
US

IV. Provider business mailing address

506 GRAHAM DR SUITE 200
TOMBALL TX
77375-3346
US

V. Phone/Fax

Practice location:
  • Phone: 281-255-3838
  • Fax: 832-201-7061
Mailing address:
  • Phone: 281-255-3838
  • Fax: 832-201-7061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON DEMATTIA
Title or Position: PRES
Credential: M.D.
Phone: 281-255-3838