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General NPI Number Information
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NPI Number | 1154638922
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Entity Type | Organization
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Legal Business Name | LOW COST HEALTH CLINIC, PLLC
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 1398 W GULF BANK RD STE F
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City | HOUSTON
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State | TX
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Zip | 77088-3532
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Country | US
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Telephone | 281-820-2500
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Fax | 281-820-2508
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Provider Business Mailing Address
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Address Line | PO BOX 3202
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City | HUMBLE
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State | TX
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Zip | 77347-3202
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Country | US
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Telephone | 832-526-4827
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Fax | 281-689-3543
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. GLORIA EVETTE WILLOUGHBY
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Credential | APRN-BC, FNP
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Telephone | 832-526-4827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 651038
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License Number State | TX
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