Provider Demographics
NPI:1437628492
Name:HOUSTON'S MENS HEALTH AND WELLNESS GROUP
Entity Type:Organization
Organization Name:HOUSTON'S MENS HEALTH AND WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-800-4382
Mailing Address - Street 1:5417 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9183
Mailing Address - Country:US
Mailing Address - Phone:956-800-4382
Mailing Address - Fax:956-800-4537
Practice Address - Street 1:5417 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9183
Practice Address - Country:US
Practice Address - Phone:956-800-4382
Practice Address - Fax:956-800-4537
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON'S MENS HEALTH AND WELLNESS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty