Provider Demographics
NPI:1396423315
Name:CHAMPION HEALTH AND WELLNESS CENTERS
Entity type:Organization
Organization Name:CHAMPION HEALTH AND WELLNESS CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP
Authorized Official - Phone:832-628-3387
Mailing Address - Street 1:2450 LOUISIANA ST # 400-248
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2380
Mailing Address - Country:US
Mailing Address - Phone:281-501-0611
Mailing Address - Fax:713-583-6299
Practice Address - Street 1:4295 SAN FELIPE ST STE 235
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-2951
Practice Address - Country:US
Practice Address - Phone:281-501-0611
Practice Address - Fax:713-583-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty