MEDICARE: VILLAGE MEDICAL GROUP

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	213ES0103X	Foot & Ankle Surgery Podiatrist	1971	TX
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	G3784	TX

General Provider Information

NPI Number	:	1558332338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	9235 KATY FWY STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1507
Country	:	US
Telephone Number	:	713-468-5009
Fax Number	:	713-468-4012

Provider Business Practice Location Address
First Line	:	9055 KATY FWY
Second Line	:	SUITE 306
City	:	HOUSTON
State	:	TX
Zip	:	77024-1624
Country	:	US
Telephone Number	:	713-468-5009
Fax Number	:	713-468-4012

Authorized Official
Title or Position	:	PARTNER
Name	:	CLIVE K FIELDS
Credential	:
Telephone Number	:	713-461-2915

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	01/14/2019

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Directions to “VILLAGE MEDICAL GROUP ” Practice Location

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