MEDICARE: POP IN TELEHEALTH CLINIC, 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1447863931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POP IN TELEHEALTH CLINIC, PLLC

Provider Business Mailing Address
First Line	:	18103 SUNFLOWER GROVE CT
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3505
Country	:	US
Telephone Number	:	281-224-2554
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 N SAM HOUSTON PKWY E STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-2413
Country	:	US
Telephone Number	:	713-331-9924
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	SONCERIA ROPER
Credential	:	NP
Telephone Number	:	713-331-9924

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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