Provider Demographics
NPI:1639507064
Name:TEXAS CITY CLINIC PLLC
Entity Type:Organization
Organization Name:TEXAS CITY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CATHARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NFORMANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-660-7280
Mailing Address - Street 1:8030 FM 1765 STE C102
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-3689
Mailing Address - Country:US
Mailing Address - Phone:832-660-7280
Mailing Address - Fax:
Practice Address - Street 1:8030 FM 1765 STE C102
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-3689
Practice Address - Country:US
Practice Address - Phone:832-660-7280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX747302261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN