MEDICARE: ADVANCED PRIMARY CARE HOUSE CALLS INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1134965478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PRIMARY CARE HOUSE CALLS INC

Provider Business Mailing Address
First Line	:	24302 DIXON SHOALS RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3748
Country	:	US
Telephone Number	:	832-293-0050
Fax Number	:

Provider Business Practice Location Address
First Line	:	24302 DIXON SHOALS RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3748
Country	:	US
Telephone Number	:	832-293-0050
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	OBIAGELI N OLOFINMOYIN
Credential	:	NP
Telephone Number	:	832-293-0050

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/05/2024

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