Provider Demographics
NPI:1144798075
Name:IMMEDIATE CARE MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:IMMEDIATE CARE MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HANG
Authorized Official - Middle Name:A
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:832-843-7075
Mailing Address - Street 1:1101 ALMA ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4559
Mailing Address - Country:US
Mailing Address - Phone:832-843-7075
Mailing Address - Fax:832-843-7157
Practice Address - Street 1:1101 ALMA ST STE 102
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4559
Practice Address - Country:US
Practice Address - Phone:832-843-7075
Practice Address - Fax:832-843-7157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3929531Medicaid
TXPENDINGMedicaid