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General NPI Number Information
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NPI Number | 1164140984
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Entity Type | Organization
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Legal Business Name | SAGESTAR HEALTH & WELLNESS CLINIC PLLC
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 2626 S LOOP W STE 430
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City | HOUSTON
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State | TX
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Zip | 77054-2649
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Country | US
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Telephone | 713-560-1459
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Fax |
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Provider Business Mailing Address
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Address Line | 4918 BEEKMAN DR
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City | MISSOURI CITY
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State | TX
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Zip | 77459-1209
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Country | US
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Telephone | 713-560-1459
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Fax | 281-972-9242
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Authorized Official
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Title or Position | PRESIDENT/CEO/PROVIDER
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Name | SARAMMA MATHEW RUSSELL
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Credential | DNP, FNP-BC, APRN
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Telephone | 713-560-1459
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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 |
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License Number State |
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