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General NPI Number Information
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NPI Number | 1841509395
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Entity Type | Organization
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Legal Business Name | PASADENA COMMUNITY HEALTH GROUP LLC
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 4002 BURKE RD
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City | PASADENA
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State | TX
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Zip | 77504-3451
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Country | US
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Telephone | 281-606-2020
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Fax | 281-606-2021
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Provider Business Mailing Address
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Address Line | 4002 BURKE RD
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City | PASADENA
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State | TX
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Zip | 77504-3451
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Country | US
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Telephone | 281-606-2020
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Fax | 281-606-2021
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STANTON PACKARD
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Credential | M.D.
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Telephone | 281-606-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | J6641
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | J6641
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | J6641
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License Number State | TX
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