MEDICARE: FAMILY PRACTICE CLINIC OF CRESTWATER 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1861594517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRACTICE CLINIC OF CRESTWATER LLC

Provider Business Mailing Address
First Line	:	17121 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-1259
Country	:	US
Telephone Number	:	281-242-0581
Fax Number	:	281-242-0582

Provider Business Practice Location Address
First Line	:	17121 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-1259
Country	:	US
Telephone Number	:	281-242-0581
Fax Number	:	281-242-0582

Authorized Official
Title or Position	:	PHYSICIAN-OWNER
Name	:	ARNOLD CAROTHERS
Credential	:	DO
Telephone Number	:	281-242-0581

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/10/2007

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