Provider Demographics
NPI:1376012732
Name:CREEKSIDE INTEGRATIVE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:CREEKSIDE INTEGRATIVE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GABOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FARKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-993-2225
Mailing Address - Street 1:3344 E FM 528 RD
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5012
Mailing Address - Country:US
Mailing Address - Phone:281-993-2225
Mailing Address - Fax:
Practice Address - Street 1:3344 E FM 528 RD
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5012
Practice Address - Country:US
Practice Address - Phone:281-993-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty