Provider Demographics
NPI:1952127441
Name:FRESH CLINICS
Entity type:Organization
Organization Name:FRESH CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL LEADER AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:937-409-4619
Mailing Address - Street 1:5900 BALCONES DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:888-925-1462
Mailing Address - Fax:
Practice Address - Street 1:2900 POST OAK BLVD STE 4100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056
Practice Address - Country:US
Practice Address - Phone:888-925-1462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center