| Mychn Lake Jackson | |
|
120 Flag Lake Dr Ste 2 Lake Jackson TX 77566-6292 | |
| (281) 824-1480 | |
| (281) 220-6407 |
| Full Name | Mychn Lake Jackson |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 120 Flag Lake Dr Ste 2, Lake Jackson, Texas |
| Authorized Official Name and Position | Courtney Gaines (CREDENTIALING COORDINATOR II) |
| Authorized Official Contact | 2818241480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mychn Lake Jackson 1612 Callaway Dr Alvin TX 77511-3743 Ph: (281) 824-1480 | Mychn Lake Jackson 120 Flag Lake Dr Ste 2 Lake Jackson TX 77566-6292 Ph: (281) 824-1480 |
| NPI Number | 1144905415 |
|---|---|
| Provider Enumeration Date | 06/15/2023 |
| Last Update Date | 11/25/2025 |
| Certification Date | 11/25/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144905415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | () | Secondary |
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