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NPI Code Detail

MEDICARE: SPRING BRANCH COMMUNITY HEALTH CENTER

MEDICARE: SPRING BRANCH COMMUNITY HEALTH CENTER
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
1172V00000XCommunity Health Worker
2208000000XPediatrics Physician
3251B00000XCase Management Agency
4363LX0001XObstetrics & Gynecology Nurse Practitioner
5261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1093186728
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPRING BRANCH COMMUNITY HEALTH CENTER
Provider Business Mailing Address
First Line : 5502 1ST ST
Second Line :
City : KATY
State : TX
Zip : 77493-2472
Country : US
Telephone Number : 713-462-6565
Fax Number : 832-831-5369
Provider Business Practice Location Address
First Line : 1905 JACQUELYN DR # 101
Second Line :
City : HOUSTON
State : TX
Zip : 77055-2502
Country : US
Telephone Number : 713-462-6565
Fax Number : 713-732-9665
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MARLEN J TUJILLO
Credential : MBA
Telephone Number : 713-462-6565
Provider Enumeration Date : 10/07/2015
Last Update Date : 06/20/2025

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1033927165 — MRS. BRIANA MIGNON HEARD CHARVIS
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Directions to “SPRING BRANCH COMMUNITY HEALTH CENTER ” Practice Location

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