| Avenue 360 Northeast | |
|
9816 Memorial Blvd Suite 120 Humble TX 77338 | |
| (713) 426-0027 | |
| (832) 209-7186 |
| Full Name | Avenue 360 Northeast |
|---|---|
| Speciality | Clinic/Center |
| Location | 9816 Memorial Blvd, Humble, Texas |
| Authorized Official Name and Position | April Peer (CFO) |
| Authorized Official Contact | 7134260027 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avenue 360 Northeast 2150 W. 18th Street Suite 300 Houston TX 77008 Ph: (713) 426-0027 | Avenue 360 Northeast 9816 Memorial Blvd Suite 120 Humble TX 77338 Ph: (713) 426-0027 |
| NPI Number | 1154817450 |
|---|---|
| Provider Enumeration Date | 07/10/2018 |
| Last Update Date | 11/10/2021 |
| Medicare PECOS PAC ID | 6608977095 |
|---|---|
| Medicare Enrollment ID | O20190207002540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154817450 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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