Provider Demographics
NPI:1568590610
Name:LONE STAR COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:LONE STAR COMMUNITY HEALTH CENTER, INC.
Other - Org Name:LONE STAR FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-539-4004
Mailing Address - Street 1:605 S CONROE MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4722
Mailing Address - Country:US
Mailing Address - Phone:936-539-4004
Mailing Address - Fax:936-521-3964
Practice Address - Street 1:605 S CONROE MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4722
Practice Address - Country:US
Practice Address - Phone:936-539-4004
Practice Address - Fax:936-521-3964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONE STAR COMMUNITY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163038601Medicaid
TX00811UMedicare ID - Type Unspecified