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General NPI Number Information
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NPI Number | 1093441149
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Entity Type | Organization
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Legal Business Name | OUR FAMILY WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 2646 S LOOP W STE 360
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City | HOUSTON
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State | TX
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Zip | 77054-2688
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Country | US
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Telephone | 346-802-2797
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Fax | 281-501-2063
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Provider Business Mailing Address
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Address Line | 2646 S LOOP W STE 360
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City | HOUSTON
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State | TX
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Zip | 77054-2688
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Country | US
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Telephone | 346-802-2797
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Fax | 281-501-2063
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Authorized Official
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Title or Position | OWNER
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Name | DERRICK J LONDOW
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Credential |
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Telephone | 346-802-2797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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