MEDICARE: KAZAH HEALTH AND WELLNESS 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	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1801470257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAZAH HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	7515 MAIN ST STE 510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4513
Country	:	US
Telephone Number	:	346-571-2824
Fax Number	:	346-571-2453

Provider Business Practice Location Address
First Line	:	7515 MAIN ST STE 510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4513
Country	:	US
Telephone Number	:	346-571-2824
Fax Number	:	346-571-2453

Authorized Official
Title or Position	:	MANAGER
Name	:	KATRINA WYMAN
Credential	:	CC /CASE MANAGER
Telephone Number	:	346-571-2824

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	05/11/2021

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Directions to “KAZAH HEALTH AND WELLNESS LLC ” Practice Location

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