Provider Demographics
NPI:1033650544
Name:CHAMPION WELLNESS PHYSICIANS GROUP PLLC
Entity Type:Organization
Organization Name:CHAMPION WELLNESS PHYSICIANS GROUP PLLC
Other - Org Name:ALPHA MEN'S CLINIC BROWNSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-412-3131
Mailing Address - Street 1:4770 N EXPRESSWAY # 83
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4165
Mailing Address - Country:US
Mailing Address - Phone:956-350-8380
Mailing Address - Fax:956-350-8371
Practice Address - Street 1:4770 N EXPRESSWAY # 83
Practice Address - Street 2:SUITE 204
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4165
Practice Address - Country:US
Practice Address - Phone:956-350-8380
Practice Address - Fax:956-350-8371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8525261Q00000X
TXH8872261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center