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NPI Code Detail

MEDICARE: PROVIDENCE PHYSICIAN ASSOCIATES

MEDICARE: PROVIDENCE PHYSICIAN ASSOCIATES
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
1261QU0200XUrgent Care Clinic/Center

General Provider Information

NPI Number : 1760919880
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE PHYSICIAN ASSOCIATES
Provider Business Mailing Address
First Line : 6306 FAIRBANKS N HOUSTON RD STE 500
Second Line :
City : HOUSTON
State : TX
Zip : 77040-5193
Country : US
Telephone Number : 832-831-9094
Fax Number :
Provider Business Practice Location Address
First Line : 6306 FAIRBANKS N HOUSTON RD STE 500
Second Line :
City : HOUSTON
State : TX
Zip : 77040-5193
Country : US
Telephone Number : 832-831-9094
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : BABATUNDE OTINWA
Credential :
Telephone Number : 832-831-9094
Provider Enumeration Date : 05/19/2017
Last Update Date : 11/13/2024

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Directions to “PROVIDENCE PHYSICIAN ASSOCIATES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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