Provider Demographics
NPI:1154638922
Name:LOW COST HEALTH CLINIC, PLLC
Entity Type:Organization
Organization Name:LOW COST HEALTH CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC, FNP
Authorized Official - Phone:832-526-4827
Mailing Address - Street 1:PO BOX 3202
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-3202
Mailing Address - Country:US
Mailing Address - Phone:832-526-4827
Mailing Address - Fax:281-689-3543
Practice Address - Street 1:1398 W GULF BANK RD
Practice Address - Street 2:STE F
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-3532
Practice Address - Country:US
Practice Address - Phone:281-820-2500
Practice Address - Fax:281-820-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651038261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care