=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083619191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE FAMILY PRACTICE, L.L.P
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2005
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9055 KATY FWY STE 200
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024-1629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-461-2915
-----------------------------------------------------
Fax | 713-461-5307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20771
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-257-6915
-----------------------------------------------------
Fax | 346-766-0604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CLIVE K FIELDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 346-766-0604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | H4289
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | H6216
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------