NPI 1124423736

Deontology

Organisation Exclusive Provider Organization Houston, TX

Practice location

Address: 6022 Belneath St, Houston, TX 77033
Phone: (832) 689-9460
Mailing address: 6022 Belneath, Houston, TX 77033

Authorised official

Name: Deonte Broussard
Title: Counselor
Phone: (832) 689-9460

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 70182 (TX)

Other Exclusive Provider Organization providers in Texas →

Registry record

NPI: 1124423736
Entity type: Organization
NPI issued: 24 Oct 2014
Record last updated: 24 Oct 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.