Provider Demographics
NPI:1508049271
Name:GRIFFITH FAMILY HEALTH AND CONVENIENT CARE CENTER
Entity Type:Organization
Organization Name:GRIFFITH FAMILY HEALTH AND CONVENIENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-C
Authorized Official - Phone:409-886-8700
Mailing Address - Street 1:3838 WEST PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-1812
Mailing Address - Country:US
Mailing Address - Phone:409-886-8700
Mailing Address - Fax:
Practice Address - Street 1:3838 WEST PARK AVENUE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-1812
Practice Address - Country:US
Practice Address - Phone:409-886-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640987261QP2300X
363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457702540OtherINDIVIDUAL NPI
TX1407871676OtherINDIVIDUAL NPI