MEDICARE: LONE STAR COMMUNITY HEALTH CENTER, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

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

General Provider Information

NPI Number	:	1679096358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR COMMUNITY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	605 S CONROE MEDICAL DR
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-4722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13905 GRANGERLAND RD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77306-7809
Country	:	US
Telephone Number	:	936-539-4004
Fax Number	:	936-539-5997

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	KAREN HARWELL
Credential	:
Telephone Number	:	936-539-4004

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	07/14/2021

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