MEDICARE: KATY FAMILY MEDICINE AND URGENT CARE 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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1972299089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATY FAMILY MEDICINE AND URGENT CARE CLINIC LLC

Provider Business Mailing Address
First Line	:	1230 RYANN ROSE CREEK LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-4053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21922 BELLAIRE BLVD STE 600
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3919
Country	:	US
Telephone Number	:	832-402-6326
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	STELLA EKONG
Credential	:	MD
Telephone Number	:	763-498-1452

Provider Enumeration Date	:	04/12/2023
Last Update Date	:	04/10/2025

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