Provider Demographics
NPI:1629513361
Name:MPACT HEALTHCARE
Entity Type:Organization
Organization Name:MPACT HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MBA, MHA
Authorized Official - Phone:832-846-9296
Mailing Address - Street 1:123 SWEET GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-2125
Mailing Address - Country:US
Mailing Address - Phone:832-846-9296
Mailing Address - Fax:
Practice Address - Street 1:123 SWEET GARDEN DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-2125
Practice Address - Country:US
Practice Address - Phone:832-846-9296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX818614251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management