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NPI Code Detail

MEDICARE: SPRING BRANCH COMMUNITY HEALTH CENTER

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 License Number License Number State
1172V00000XCommunity Health Worker
2261QF0400XFederally Qualified Health Center (FQHC)N2861TX
3208000000XPediatrics Physician
4251B00000XCase Management Agency
5261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558688135
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 : 713-462-6581
Provider Business Practice Location Address
First Line : 8575 PITNER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77080-2010
Country : US
Telephone Number : 713-462-6545
Fax Number : 713-462-6581
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MARLEN TRUJILLO
Credential :
Telephone Number : 713-462-6556
Provider Enumeration Date : 04/22/2010
Last Update Date : 09/11/2024

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Directions to “SPRING BRANCH COMMUNITY HEALTH CENTER ” Practice Location

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