=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396045522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPRING MINOR CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2010
-----------------------------------------------------
Last Update Date | 10/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1136 GRAND AVE
-----------------------------------------------------
City | BACLIFF
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77518-2760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-621-4464
-----------------------------------------------------
Fax | 713-624-7775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6300 RICHMOND AVE SUITE 333
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-5931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-621-4464
-----------------------------------------------------
Fax | 713-621-7775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | TANYA CISNEROS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-621-4464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------