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General NPI Number Information
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NPI Number | 1275882128
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Entity Type | Organization
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Legal Business Name | MONTGOMERY COUNTY PUBLIC HEALTH DISTRICT
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 1300 S LOOP 336 W
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City | CONROE
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State | TX
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Zip | 77304-3316
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Country | US
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Telephone | 936-523-5020
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Fax | 936-523-5193
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Provider Business Mailing Address
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Address Line | 1400 S LOOP 336 W
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City | CONROE
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State | TX
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Zip | 77304-3317
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Country | US
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Telephone | 936-523-5000
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Fax | 936-523-1166
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RANDY EDWIN JOHNSON
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Credential |
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Telephone | 936-523-5113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 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 #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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