Provider Demographics
NPI:1164724886
Name:PHYSICIANS FAMILY CLINIC
Entity Type:Organization
Organization Name:PHYSICIANS FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:NGENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-488-7331
Mailing Address - Street 1:4302 IRON CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5277
Mailing Address - Country:US
Mailing Address - Phone:832-488-7331
Mailing Address - Fax:
Practice Address - Street 1:5445 ALMEDA RD
Practice Address - Street 2:STE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7434
Practice Address - Country:US
Practice Address - Phone:832-488-7331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty