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General NPI Number Information
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NPI Number | 1730590761
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Entity Type | Organization
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Legal Business Name | INCLUSIVE HEALTHCARE GROUP, LLC
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 6550 MAPLERIDGE ST # 115
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City | HOUSTON
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State | TX
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Zip | 77081-4600
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Country | US
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Telephone | 832-649-7919
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Fax | 888-812-4235
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Provider Business Mailing Address
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Address Line | 6550 MAPLERIDGE ST #117
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City | HOUSTON
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State | TX
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Zip | 77081-4600
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Country | US
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Telephone | 832-649-7919
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Fax | 888-812-4235
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Authorized Official
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Title or Position | OPERATIONS OFFICER
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Name | DAMEON TRYON
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Credential |
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Telephone | 832-946-7919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 801859664
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 801859664
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 801859664
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 801859664
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License Number State | TX
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