MEDICARE: NASA HEALTH CLINIC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1740661453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASA HEALTH CLINIC

Provider Business Mailing Address
First Line	:	985 NASA PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3039
Country	:	US
Telephone Number	:	281-218-6777
Fax Number	:

Provider Business Practice Location Address
First Line	:	985 NASA PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3039
Country	:	US
Telephone Number	:	713-893-6214
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	BRAD PETERSON
Credential	:
Telephone Number	:	713-893-6214

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	02/10/2021

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Directions to “NASA HEALTH CLINIC ” Practice Location

Language	Start Address	Practice Location

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