Provider Demographics
NPI:1205296779
Name:COUNTRY PLACE MEDICAL CENTER LLC
Entity type:Organization
Organization Name:COUNTRY PLACE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-926-3408
Mailing Address - Street 1:1920 COUNTRY PLACE PKWY
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2282
Mailing Address - Country:US
Mailing Address - Phone:630-926-3408
Mailing Address - Fax:
Practice Address - Street 1:1920 COUNTRY PLACE PKWY
Practice Address - Street 2:SUITE 340
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2282
Practice Address - Country:US
Practice Address - Phone:630-926-3408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty