Provider Demographics
NPI:1609317775
Name:PASADENA PHYSICIANS MEDICAL MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:PASADENA PHYSICIANS MEDICAL MANAGEMENT GROUP LLC
Other - Org Name:CRENSHAW URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOUHEIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-258-4836
Mailing Address - Street 1:5044 CRENSHAW ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3047
Mailing Address - Country:US
Mailing Address - Phone:281-258-4836
Mailing Address - Fax:
Practice Address - Street 1:5044 CRENSHAW ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3047
Practice Address - Country:US
Practice Address - Phone:281-258-4836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care