MEDICARE: PASADENA URGENCY CENTER LLC LLC

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
2	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1366890725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASADENA URGENCY CENTER LLC LLC

Provider Business Mailing Address
First Line	:	6800 WEST LOOP S
Second Line	:	SUITE 300
City	:	BELLAIRE
State	:	TX
Zip	:	77401-4528
Country	:	US
Telephone Number	:	713-838-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5161 E SAM HOUSTON PKWY S
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-3915
Country	:	US
Telephone Number	:	713-838-0800
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DR. KELLY LARKIN
Credential	:	MD
Telephone Number	:	713-838-0800

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	12/22/2016

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