MEDICARE: MONT BELVIEU URGENT CARE LLC

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1679353916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONT BELVIEU URGENT CARE LLC

Provider Business Mailing Address
First Line	:	9235 N HIGHWAY 146 STE 2
Second Line	:
City	:	MONT BELVIEU
State	:	TX
Zip	:	77523-9503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9235 N HIGHWAY 146 STE 2
Second Line	:
City	:	MONT BELVIEU
State	:	TX
Zip	:	77523-9503
Country	:	US
Telephone Number	:	281-385-8111
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DOUGLAS CHUNG
Credential	:
Telephone Number	:	281-385-8111

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	10/04/2023

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