Provider Demographics
NPI:1720681851
Name:GLO FAMILY CARE CLINIC LLC
Entity Type:Organization
Organization Name:GLO FAMILY CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IJIE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:757-270-3826
Mailing Address - Street 1:7427 CHATHAN GLEN LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3849
Mailing Address - Country:US
Mailing Address - Phone:832-400-2944
Mailing Address - Fax:
Practice Address - Street 1:7427 CHATHAN GLEN LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3849
Practice Address - Country:US
Practice Address - Phone:832-400-2944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty