Healthcare Provider Details

I. General information

NPI: 1689178139
Provider Name (Legal Business Name): MOC WEBSTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16130 GALVESTON ROAD
WEBSTER TX
77598
US

IV. Provider business mailing address

1320 ARROW POINT DR STE 506
CEDAR PARK TX
78613-2189
US

V. Phone/Fax

Practice location:
  • Phone: 512-524-7321
  • Fax:
Mailing address:
  • Phone: 512-524-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: MARK FRITZ
Title or Position: PRESIDENT
Credential:
Phone: 512-524-7321