Provider Demographics
NPI:1275805806
Name:DAILY GREEN FAMILY HEALTH & CONVENIENT CARE, PLLC
Entity Type:Organization
Organization Name:DAILY GREEN FAMILY HEALTH & CONVENIENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:PORTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-745-4130
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:MAURICEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77626-0660
Mailing Address - Country:US
Mailing Address - Phone:409-745-4130
Mailing Address - Fax:409-745-4187
Practice Address - Street 1:11980 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77632-7822
Practice Address - Country:US
Practice Address - Phone:409-745-4130
Practice Address - Fax:409-745-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty