Provider Demographics
NPI:1912453473
Name:WOODLANDS FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:WOODLANDS FAMILY MEDICINE PLLC
Other - Org Name:WOODLANDS FAMILY MEDICINE PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-229-7427
Mailing Address - Street 1:4185 TECHNOLOGY FOREST BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2005
Mailing Address - Country:US
Mailing Address - Phone:936-447-9483
Mailing Address - Fax:936-447-9410
Practice Address - Street 1:4185 TECHNOLOGY FOREST BLVD STE 210
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2005
Practice Address - Country:US
Practice Address - Phone:936-447-9483
Practice Address - Fax:936-447-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB23910Medicare UPIN
TX8C2420Medicare PIN
TXH89341Medicare UPIN
TX86M956Medicare PIN