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NPI Code Detail

MEDICARE: SPO FAMILY CARE MEDICAL CLINIC LLC

MEDICARE: SPO FAMILY CARE MEDICAL CLINIC 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
1208D00000XGeneral Practice PhysicianJ4168TX

General Provider Information

NPI Number : 1902101736
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPO FAMILY CARE MEDICAL CLINIC LLC
Provider Business Mailing Address
First Line : 14215 S POST OAK RD
Second Line :
City : HOUSTON
State : TX
Zip : 77045-5233
Country : US
Telephone Number : 713-433-4536
Fax Number : 713-433-6708
Provider Business Practice Location Address
First Line : 14215 S POST OAK RD
Second Line :
City : HOUSTON
State : TX
Zip : 77045-5233
Country : US
Telephone Number : 713-433-4536
Fax Number : 713-433-6708
Authorized Official
Title or Position : OWNER
Name : MR. CHARLES AHAIWE
Credential :
Telephone Number : 713-562-3195
Provider Enumeration Date : 01/26/2011
Last Update Date : 10/05/2011

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Directions to “SPO FAMILY CARE MEDICAL CLINIC LLC ” Practice Location

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