Provider Demographics
NPI:1093186728
Name:SPRING BRANCH COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SPRING BRANCH COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:713-462-6565
Mailing Address - Street 1:800 WEST SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042
Mailing Address - Country:US
Mailing Address - Phone:713-462-6565
Mailing Address - Fax:832-831-5369
Practice Address - Street 1:1905 JACQUELYN DR # 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-2502
Practice Address - Country:US
Practice Address - Phone:713-462-6565
Practice Address - Fax:713-732-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty