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General NPI Number Information
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NPI Number | 1629524376
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Entity Type | Organization
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Legal Business Name | NUPHYSICIA HEALTH OF TEXAS
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 4625 SOUTHWEST FWY SUITE 142
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City | HOUSTON
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State | TX
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Zip | 77027-7100
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Country | US
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Telephone | 713-358-9271
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Fax | 713-358-9269
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Provider Business Mailing Address
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Address Line | 4625 SOUTHWEST FREEWAY SUITE 142
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City | HOUSTON
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State | TX
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Zip | 77027
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Country | US
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Telephone | 713-358-9271
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Fax | 713-358-9269
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. OSCAR WILLIAM BOULTINGHOUSE
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Credential | M.D.
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Telephone | 713-358-9271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | G2256
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License Number State | TX
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