# 290 MANGUM HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164726956
- **Authorized official:** MR. TABARE D TABAR P A (MANAGER)
- **Authorized official phone:** (713) 682-2212

## Contact information

- **Practice address:** 5005 W 34TH ST, SUITE 102C, HOUSTON, TX 77092-4200
- **Practice address phone:** (713) 682-2212
- **Practice address fax:** (713) 682-9997
- **Mailing address:** 5005 W 34TH ST, SUITE 102C, HOUSTON, TX 77092-4200
- **Mailing address phone:** (713) 682-2212
- **Mailing address fax:** (713) 682-9997

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | PA01537 | TX | Yes |

## Other

- **Enumeration date:** 01/07/2011
- **Last updated:** 01/07/2011