Provider Demographics
NPI:1558620559
Name:SCARBOROUGH FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:SCARBOROUGH FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-943-2800
Mailing Address - Street 1:3 WATERMINT PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4770
Mailing Address - Country:US
Mailing Address - Phone:281-943-2800
Mailing Address - Fax:281-943-2810
Practice Address - Street 1:603 S CONROE MEDICAL DR STE 110
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5395
Practice Address - Country:US
Practice Address - Phone:936-760-9900
Practice Address - Fax:281-943-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty