=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639982069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONE STAR COMMUNITY HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2025
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 S CONROE MEDICAL DR STE 100
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-4722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-521-8471
-----------------------------------------------------
Fax | 936-539-4019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 S CONROE MEDICAL DR
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77304-4722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-539-4004
-----------------------------------------------------
Fax | 936-539-3635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | KAREN HARWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 936-539-4004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------