Provider Demographics
NPI:1871026344
Name:SYNERGENX HEALTH - GALLERIA LLC
Entity Type:Organization
Organization Name:SYNERGENX HEALTH - GALLERIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WELTON
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-429-8522
Mailing Address - Street 1:16131 N ELDRIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-9130
Mailing Address - Country:US
Mailing Address - Phone:281-429-8522
Mailing Address - Fax:281-970-5913
Practice Address - Street 1:3651 WESLAYAN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6833
Practice Address - Country:US
Practice Address - Phone:281-970-5900
Practice Address - Fax:281-970-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care