Provider Demographics
NPI:1740797539
Name:BRAESWOOD URGENT CARE AND FAMILY CLINIC
Entity Type:Organization
Organization Name:BRAESWOOD URGENT CARE AND FAMILY CLINIC
Other - Org Name:BRAESWOOD URGENT CARE AND FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPPAR
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:281-888-5598
Mailing Address - Street 1:8622 S BRAESWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-1301
Mailing Address - Country:US
Mailing Address - Phone:281-888-5598
Mailing Address - Fax:
Practice Address - Street 1:8622 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-1301
Practice Address - Country:US
Practice Address - Phone:281-888-5598
Practice Address - Fax:281-888-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
TX760924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1891102745Medicaid
TX1982709465Medicaid