Provider Demographics
NPI:1629421219
Name:PREFERRED CHOICE FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:PREFERRED CHOICE FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-731-5092
Mailing Address - Street 1:5410 PECAN PASS CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-0138
Mailing Address - Country:US
Mailing Address - Phone:281-731-5092
Mailing Address - Fax:832-327-1806
Practice Address - Street 1:5410 PECAN PASS CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-0138
Practice Address - Country:US
Practice Address - Phone:281-731-5092
Practice Address - Fax:832-327-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320515501Medicaid
TX265295YKYNMedicare UPIN