=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861849416
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UHPHEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2016
-----------------------------------------------------
Last Update Date | 09/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 ROCKLEIGH PL
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77017-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-352-3118
-----------------------------------------------------
Fax | 713-321-2737
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 ROCKLEIGH PL
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77017-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-974-1378
-----------------------------------------------------
Fax | 713-321-2737
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. BERNICE J KOKO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-419-5583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------