Provider Demographics
NPI:1407334899
Name:FRIENDSWOOD CENTER FOR FAMILY HEALTH LLP
Entity Type:Organization
Organization Name:FRIENDSWOOD CENTER FOR FAMILY HEALTH LLP
Other - Org Name:FRIENDSWOOD CENTER FOR FAMILY HEALTH PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-482-5551
Mailing Address - Street 1:4 OAKTREE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4073
Mailing Address - Country:US
Mailing Address - Phone:281-482-5551
Mailing Address - Fax:281-482-0993
Practice Address - Street 1:4 OAKTREE ST STE 2
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546
Practice Address - Country:US
Practice Address - Phone:281-482-5551
Practice Address - Fax:281-482-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204225101Medicaid