Provider Demographics
NPI:1912294380
Name:CYPRESS CREEK PHYSICIAN MANAGEMENT
Entity Type:Organization
Organization Name:CYPRESS CREEK PHYSICIAN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-453-7916
Mailing Address - Street 1:847 FM 1960 RD W
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3403
Mailing Address - Country:US
Mailing Address - Phone:281-453-7916
Mailing Address - Fax:281-440-2020
Practice Address - Street 1:847 FM 1960 RD W
Practice Address - Street 2:SUITE 100A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3403
Practice Address - Country:US
Practice Address - Phone:281-453-7916
Practice Address - Fax:281-440-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2085R0202X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty