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General NPI Number Information
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NPI Number | 1831510510
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Entity Type | Organization
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Legal Business Name | 1488 URGENT CARE CLINIC, LLC
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 3600 FM 1488 RD STE. 200
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City | CONROE
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State | TX
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Zip | 77384-3817
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Country | US
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Telephone | 718-480-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 FM 1488 RD STE. 200
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City | CONROE
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State | TX
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Zip | 77384-3817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | JOHN PRUDHOMME
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Credential |
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Telephone | 713-785-1119
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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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