Provider Demographics
NPI:1760545826
Name:PASADENA FAMILY CLINIC
Entity Type:Organization
Organization Name:PASADENA FAMILY CLINIC
Other - Org Name:LAVA ROCK FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-473-3341
Mailing Address - Street 1:1907 SOUTHMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-1314
Mailing Address - Country:US
Mailing Address - Phone:713-473-3341
Mailing Address - Fax:713-473-0260
Practice Address - Street 1:1907 SOUTHMORE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1314
Practice Address - Country:US
Practice Address - Phone:713-473-3341
Practice Address - Fax:713-473-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H41EMedicare ID - Type UnspecifiedMEDICARE