Provider Demographics
NPI:1700179991
Name:DIVINE FAMILY CLINIC, INC.
Entity Type:Organization
Organization Name:DIVINE FAMILY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-433-4400
Mailing Address - Street 1:14522 S POST OAK RD
Mailing Address - Street 2:203B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-6037
Mailing Address - Country:US
Mailing Address - Phone:713-433-4400
Mailing Address - Fax:
Practice Address - Street 1:14522 S POST OAK RD
Practice Address - Street 2:203B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-6037
Practice Address - Country:US
Practice Address - Phone:713-433-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty