Provider Demographics
NPI:1922384478
Name:SHADOW CREEK FAMILY PHYSICIANS PA
Entity Type:Organization
Organization Name:SHADOW CREEK FAMILY PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISHALI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-436-3697
Mailing Address - Street 1:10970 SHADOW CREEK PKWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0100
Mailing Address - Country:US
Mailing Address - Phone:713-436-3697
Mailing Address - Fax:
Practice Address - Street 1:10970 SHADOW CREEK PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-0123
Practice Address - Country:US
Practice Address - Phone:713-436-3697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty