| Tracy Amerson-rivers | |
|
2646 S Loop W Houston TX 77054-2665 | |
| (832) 297-9279 | |
| (281) 533-8175 |
| Full Name | Tracy Amerson-rivers |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2646 S Loop W, Houston, Texas |
| Authorized Official Name and Position | Tracy Amerson-rivers (CEO/FOUNDER) |
| Authorized Official Contact | 8322979279 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracy Amerson-rivers Po Box 1067 Katy TX 77492-1067 Ph: (870) 740-8850 | Tracy Amerson-rivers 2646 S Loop W Houston TX 77054-2665 Ph: (832) 297-9279 |
| NPI Number | 1073188835 |
|---|---|
| Provider Enumeration Date | 05/24/2021 |
| Last Update Date | 05/10/2022 |
| Certification Date | 05/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073188835 | NPI | - | NPPES |
| 14485757 | Other | CAQH PROVIDER ID | |
| 073789087 | Other | DUNS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (NU) | Primary |
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