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General NPI Number Information
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NPI Number | 1669412250
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Entity Type | Organization
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Legal Business Name | PREMIER HOUSTON AREA FAMILY MEDICAL CLINICS
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 2211 A E. BROADWAY
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City | PEARLAND
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State | TX
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Zip | 77581
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Country | US
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Telephone | 281-485-6144
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Fax | 281-485-6146
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Provider Business Mailing Address
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Address Line | 2211 A E. BROADWAY
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City | PEARLAND
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State | TX
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Zip | 77581
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Country | US
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Telephone | 281-485-6144
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Fax | 281-485-6146
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MS. MARIE D. MENGARELLI
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Credential |
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Telephone | 713-946-6081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | F5827
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F5827
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License Number State | TX
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