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
1	172V00000X	Community Health Worker
2	251B00000X	Case Management Agency
3	261QF0400X	Federally Qualified Health Center (FQHC)

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

General Provider Information

NPI Number	:	1235141409
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	:	1615 HLLLENDAHL BOULEVARD
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77055-3402
Country	:	US
Telephone Number	:	713-462-6565
Fax Number	:	713-462-6596

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MARLEN J. TRUJILLO
Credential	:
Telephone Number	:	713-462-6565

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	09/11/2024

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