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General NPI Number Information
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NPI Number | 1760919880
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Entity Type | Organization
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Legal Business Name | PROVIDENCE PHYSICIAN ASSOCIATES
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 6306 FAIRBANKS N HOUSTON RD STE 500
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City | HOUSTON
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State | TX
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Zip | 77040-5193
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Country | US
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Telephone | 832-831-9094
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Fax |
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Provider Business Mailing Address
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Address Line | 6306 FAIRBANKS N HOUSTON RD STE 500
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City | HOUSTON
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State | TX
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Zip | 77040-5193
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Country | US
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Telephone | 832-831-9094
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BABATUNDE OTINWA
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Credential |
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Telephone | 832-831-9094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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