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1013915255

NPI Code Detail

MEDICARE: KELSEY-SEYBOLD MEDICAL GROUP, PLLC

MEDICARE: KELSEY-SEYBOLD MEDICAL GROUP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207V00000X	Obstetrics & Gynecology Physician
3	207W00000X	Ophthalmology Physician
4	207X00000X	Orthopaedic Surgery Physician
5	207Y00000X	Otolaryngology Physician
6	208000000X	Pediatrics Physician
7	208100000X	Physical Medicine & Rehabilitation Physician
8	2085R0202X	Diagnostic Radiology Physician
9	208C00000X	Colon & Rectal Surgery Physician
10	111N00000X	Chiropractor
11	207Q00000X	Family Medicine Physician
12	207K00000X	Allergy & Immunology Physician
13	207N00000X	Dermatology Physician
14	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013915255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELSEY-SEYBOLD MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PARKWAY
Second Line	:	ADMINISTRATIVE OFFICES
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 W HOLCOMBE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1669
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	TAMICA WILSON
Credential	:
Telephone Number	:	713-442-4997

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/22/2022

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Directions to “KELSEY-SEYBOLD MEDICAL GROUP, PLLC ” Practice Location

Language	Start Address	Practice Location

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