| Fountains of Richmond, LLC | |
|
7103 S Peek Rd Ste 300b Richmond TX 77407-3770 | |
| (346) 560-7080 | |
| (346) 560-7081 |
| Full Name | Fountains of Richmond, LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 7103 S Peek Rd Ste 300b, Richmond, Texas |
| Authorized Official Name and Position | George Wade Phillips (OWNER) |
| Authorized Official Contact | 3465607080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fountains of Richmond, LLC 7103 S Peek Rd Ste 300b Richmond TX 77407-3770 Ph: (346) 560-7080 | Fountains of Richmond, LLC 7103 S Peek Rd Ste 300b Richmond TX 77407-3770 Ph: (346) 560-7080 |
| NPI Number | 1336960749 |
|---|---|
| Provider Enumeration Date | 10/18/2024 |
| Last Update Date | 12/20/2024 |
| Certification Date | 12/20/2024 |
| Medicare PECOS PAC ID | 6709310568 |
|---|---|
| Medicare Enrollment ID | O20241115001840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336960749 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Secondary |
| 261QI0500X | Clinic/center - Infusion Therapy | (NU) | Primary |
| Provider Name | Ambrose Campbell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669903969 PECOS PAC ID: 0941573927 Enrollment ID: I20240919002695 |
| Provider Name | Cidnea Ellen Baskinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649066507 PECOS PAC ID: 4385150804 Enrollment ID: I20250722002298 |
| Provider Name | Mallory Elizabeth Boggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013543388 PECOS PAC ID: 3678903630 Enrollment ID: I20250808000780 |
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