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General NPI Number Information
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NPI Number | 1629513361
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Entity Type | Organization
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Legal Business Name | MPACT HEALTHCARE
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 123 SWEET GARDEN DR
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City | CONROE
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State | TX
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Zip | 77384-2125
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Country | US
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Telephone | 832-846-9296
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Fax |
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Provider Business Mailing Address
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Address Line | 123 SWEET GARDEN DR
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City | CONROE
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State | TX
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Zip | 77384-2125
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Country | US
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Telephone | 832-846-9296
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. GREGORY ALLEN PIERCE
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Credential | RN, BSN, MBA, MHA
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Telephone | 832-846-9296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 818614
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License Number State | TX
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