Organization
FOURTH WARD CLINIC
Active
Parent organization
GOOD NEIGHBOR - NORTH (SATELLITE)
Other names
Good Neighbor Healthcare Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
GOOD NEIGHBOR - NORTH (SATELLITE)
Authorized official
JANET S. DONATH (EXECUTIVE DIRECTOR)
(713) 529-3597
Entity
Organization
Contact information
Practice address
8504 SCHULLER RD, HOUSTON, TX 77093
(713) 387-7171
(713) 387-7189
Mailing address
190 HEIGHTS BLVD, HOUSTON, TX 77007
(713) 529-3597
(713) 529-9169
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
TX
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126821105
FQHC MEDICAID
TX
01
—
67-1829
FQHC MEDICARE
TX
01
—
TXB106000
MEDICARE PTAN
TX
Enumeration date
05/19/2011
Last updated
05/19/2011
Update your record
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