MEDICARE: LONG POINT MD.PA.

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	305S00000X	Point of Service

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	00940V	OTHER	TX	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BJ7030	OTHER	TX	BLUECROSS
2	D4359	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1629279062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG POINT MD.PA.

Provider Business Mailing Address
First Line	:	8153 LONG POINT RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-2032
Country	:	US
Telephone Number	:	713-722-8799
Fax Number	:	713-722-8830

Provider Business Practice Location Address
First Line	:	8153 LONG POINT RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-2032
Country	:	US
Telephone Number	:	713-722-8799
Fax Number	:	713-722-8830

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. ARLENE RODRIGUEZ
Credential	:
Telephone Number	:	713-722-8799

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/22/2020

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Directions to “LONG POINT MD.PA. ” Practice Location

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