=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073409256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVOLVE HEALTH TEXAS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2025
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15200 SOUTHWEST FWY STE 250
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-3865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-900-0010
-----------------------------------------------------
Fax | 832-375-1247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15200 SOUTHWEST FWY STE 250
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-3865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-900-0010
-----------------------------------------------------
Fax | 832-375-1247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CRO
-----------------------------------------------------
Name | ADAM SIEGEL
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 813-549-5678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------