Provider Demographics
NPI:1760662647
Name:KINGWOOD FAMILY PRACTICE ASSOCIATES
Entity Type:Organization
Organization Name:KINGWOOD FAMILY PRACTICE ASSOCIATES
Other - Org Name:STEPHANIE G PIERCE ET AL PTR
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GROSS PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-361-2902
Mailing Address - Street 1:1850 W LAKE HOUSTON PKWY
Mailing Address - Street 2:190
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5237
Mailing Address - Country:US
Mailing Address - Phone:281-361-2902
Mailing Address - Fax:281-361-5792
Practice Address - Street 1:1850 W LAKE HOUSTON PKWY
Practice Address - Street 2:190
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5237
Practice Address - Country:US
Practice Address - Phone:281-361-2902
Practice Address - Fax:281-361-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00097FMedicare PIN