MEDICARE: AFFORDABLE URGENT CARE AND FAMILY PRACTICE, 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1083075576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE URGENT CARE AND FAMILY PRACTICE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 591059
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77259-1059
Country	:	US
Telephone Number	:	281-919-2061
Fax Number	:	832-461-1976

Provider Business Practice Location Address
First Line	:	5033 FM 1960 RD W
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77069-4562
Country	:	US
Telephone Number	:	281-919-2061
Fax Number	:	832-461-1976

Authorized Official
Title or Position	:	OWNER
Name	:	DEYA J DAFASHY
Credential	:	M.D.
Telephone Number	:	281-991-7603

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	08/30/2016

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