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General NPI Number Information
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NPI Number | 1093379497
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Entity Type | Organization
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Legal Business Name | THRIVE FAMILY CLINIC LLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 1853 PEARLAND PKWY STE 121
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City | PEARLAND
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State | TX
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Zip | 77581-8864
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Country | US
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Telephone | 832-300-2453
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Fax | 281-741-8139
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Provider Business Mailing Address
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Address Line | 1853 PEARLAND PKWY STE 121
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City | PEARLAND
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State | TX
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Zip | 77581-8864
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MERCEDES GILES
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Credential | MD
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Telephone | 832-300-2453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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