# AGE WELL CONCIERGE MEDICINE

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

## Provider details

- **NPI number:** 1952919490
- **Authorized official:** MONICA MILFORD FNP (COO)
- **Authorized official phone:** (936) 494-9520

## Contact information

- **Practice address:** 18441 TX-105, SUITE B, MONTGOMERY, TX 77356
- **Practice address phone:** (936) 494-9520
- **Mailing address:** 224 LAKE ESTATES DR, MONTGOMERY, TX 77356-4806
- **Mailing address phone:** (936) 494-9520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/21/2020
- **Last updated:** 07/21/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1922335199 | BCBS | TX |