Provider Demographics
NPI:1558856997
Name:NORTHCHASE FAMILY PRACTICE CLINIC
Entity Type:Organization
Organization Name:NORTHCHASE FAMILY PRACTICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-955-3919
Mailing Address - Street 1:11417 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-2601
Mailing Address - Country:US
Mailing Address - Phone:713-955-3919
Mailing Address - Fax:713-673-8016
Practice Address - Street 1:11417 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-2601
Practice Address - Country:US
Practice Address - Phone:713-955-3919
Practice Address - Fax:713-673-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty