MEDICARE: G&G FIRST CLASS MEDICAL CENTER

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	261Q00000X	Clinic/Center	K1817	TX

General Provider Information

NPI Number	:	1942526488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G&G FIRST CLASS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	13415 WOODFOREST BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-2922
Country	:	US
Telephone Number	:	713-453-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	13415 WOODFOREST BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-2922
Country	:	US
Telephone Number	:	713-453-9400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGORIUS M BROWN
Credential	:	PA
Telephone Number	:	713-453-9400

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	04/08/2010

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