Organization
GREATER GULF HEALTH PLAN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE J WEDEKIND (PRESIDENT)
(281) 447-6800
Entity
Organization
Contact information
Practice address
260 N SAM HOUSTON PKWY E STE 220, HOUSTON, TX 77060-2022
(281) 447-6800
(281) 447-6802
Mailing address
260 N SAM HOUSTON PKWY E, SUITE 220, HOUSTON, TX 77060-2018
(281) 447-6800
(281) 447-6802
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
01486663
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00690K
BCBS ID
TX
05
—
176768301
—
TX
05
—
176768302
—
TX
Enumeration date
04/11/2007
Last updated
06/18/2008
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