| Marrod Healthcare Provider, Llc. | |
|
5330 Fry Rd Katy TX 77449-6920 | |
| (832) 810-5060 | |
| (832) 810-5080 |
| Full Name | Marrod Healthcare Provider, Llc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5330 Fry Rd, Katy, Texas |
| Authorized Official Name and Position | Angel Enrique Martinez Penton (OWNER) |
| Authorized Official Contact | 8324076082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marrod Healthcare Provider, Llc. 25914 Sundrop Meadows Ln Katy TX 77494-3171 Ph: () - | Marrod Healthcare Provider, Llc. 5330 Fry Rd Katy TX 77449-6920 Ph: (832) 810-5060 |
| NPI Number | 1467230441 |
|---|---|
| Provider Enumeration Date | 09/20/2023 |
| Last Update Date | 09/20/2023 |
| Medicare PECOS PAC ID | 3577918481 |
|---|---|
| Medicare Enrollment ID | O20231012003140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467230441 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Angel E Martinez Penton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447978127 PECOS PAC ID: 8022484120 Enrollment ID: I20221014000470 |
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