Provider Demographics
NPI:1558688135
Name:SPRING BRANCH COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SPRING BRANCH COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-462-6556
Mailing Address - Street 1:800 W SAM HOUSTON PKWY S STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1914
Mailing Address - Country:US
Mailing Address - Phone:713-462-6565
Mailing Address - Fax:713-462-6581
Practice Address - Street 1:8575 PITNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-2010
Practice Address - Country:US
Practice Address - Phone:713-462-6545
Practice Address - Fax:713-462-6581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X, 261QF0400X
TXN2861261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209600001Medicaid
TX209600001Medicaid