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General NPI Number Information
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NPI Number | 1851741003
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Entity Type | Organization
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Legal Business Name | SPRING BRANCH COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 5502 1ST ST
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City | KATY
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State | TX
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Zip | 77493-2472
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Country | US
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Telephone | 713-462-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 5502 1ST ST STE 200
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City | KATY
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State | TX
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Zip | 77493-2472
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Country | US
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Telephone | 713-462-6565
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Fax | 832-831-5369
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MARLEN J TRUJILLO
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Credential | MBA
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Telephone | 713-462-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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