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General NPI Number Information
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NPI Number | 1932046182
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Entity Type | Organization
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Legal Business Name | INTERCEDE HEALTH - FIRST 30/60
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 9595 SIX PINES DRIVE SUITE 210
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City | THE WOODLANDS
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State | TX
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Zip | 77380
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Country | US
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Telephone | 832-476-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 FM 528 RD PMB 330
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City | WEBSTER
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State | TX
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Zip | 77598-4507
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Country | US
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Telephone | 832-476-3900
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DAN LOTAN
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Credential | MD
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Telephone | 832-476-3900
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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