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General NPI Number Information
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NPI Number | 1831328855
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Entity Type | Organization
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Legal Business Name | BROADWAY HEALTH GROUP LLC
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Dates
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Enumeration Date | 07/12/2009
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Last Update Date | 07/12/2009
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Provider Practice Location Address
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Address Line | 8121 BROADWAY ST STE 130
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City | HOUSTON
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State | TX
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Zip | 77061-1340
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Country | US
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Telephone | 713-645-1300
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Fax | 713-645-1301
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Provider Business Mailing Address
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Address Line | 8121 BROADWAY ST STE 130
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City | HOUSTON
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State | TX
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Zip | 77061-1340
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Country | US
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Telephone | 713-645-1300
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Fax | 713-645-1301
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Authorized Official
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Title or Position | OWNER
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Name | IAROSLAV MARYNYCH
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Credential |
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Telephone | 713-645-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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