=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548214950
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CENTER FOR FAMILY MEDICINE,WELLNESS & AESTHETICS P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 05/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 N TEXAS AVE SUITE D
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77598-4959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-827-1973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3202 ACORN WOOD WAY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77059-3174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-488-8949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ASHOK TRIPATHY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 281-235-8348
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | H8554
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------