Provider Demographics
NPI:1033369863
Name:SOUTHWEST FAMILY PRACTICE
Entity Type:Organization
Organization Name:SOUTHWEST FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNUBI
Authorized Official - Middle Name:RASHARN
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-851-0113
Mailing Address - Street 1:6065 HILLCROFT ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1087
Mailing Address - Country:US
Mailing Address - Phone:713-772-3200
Mailing Address - Fax:713-772-3202
Practice Address - Street 1:6065 HILLCROFT ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1087
Practice Address - Country:US
Practice Address - Phone:713-772-3200
Practice Address - Fax:713-772-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty