| Provisioncare Medical | |
|
11501 N Sam Houston Pkwy E Ste A Humble TX 77396-4635 | |
| (281) 652-5612 | |
| (346) 980-4054 |
| Full Name | Provisioncare Medical |
|---|---|
| Speciality | Family Medicine |
| Location | 11501 N Sam Houston Pkwy E Ste A, Humble, Texas |
| Authorized Official Name and Position | Derrick Traylor (CEO) |
| Authorized Official Contact | 5039015733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provisioncare Medical 14700 Woodson Park Dr Apt 1512 Houston TX 77044-4531 Ph: (281) 652-5612 | Provisioncare Medical 11501 N Sam Houston Pkwy E Ste A Humble TX 77396-4635 Ph: (281) 652-5612 |
| NPI Number | 1144884826 |
|---|---|
| Provider Enumeration Date | 04/28/2019 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144884826 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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