Provider Demographics
NPI:1417062621
Name:SPRING CYPRESS FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:SPRING CYPRESS FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-321-1097
Mailing Address - Street 1:18425 CHAMPION FOREST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3999
Mailing Address - Country:US
Mailing Address - Phone:281-376-4410
Mailing Address - Fax:
Practice Address - Street 1:18425 CHAMPION FOREST DR STE 200
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3999
Practice Address - Country:US
Practice Address - Phone:281-376-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0045JQOtherBCBS OF TEXAS GROUP NUMBE
TX0045JQOtherBCBS OF TEXAS GROUP NUMBE
TX00294VMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER