MEDICARE: TEXAS CITY 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	747302	TX

General Provider Information

NPI Number	:	1639507064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS CITY CLINIC PLLC

Provider Business Mailing Address
First Line	:	8030 FM 1765 STE C102
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-3689
Country	:	US
Telephone Number	:	832-660-7280
Fax Number	:

Provider Business Practice Location Address
First Line	:	8030 FM 1765 STE C102
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-3689
Country	:	US
Telephone Number	:	832-660-7280
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	CATHARINE NFORMANGUM
Credential	:	NP
Telephone Number	:	832-660-7280

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	06/20/2018

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