Organization
BRAZOSPORT HEALTH ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KARIN L. L. ZIELECK (ADMINISTRATOR)
(979) 299-1210
Entity
Organization
Contact information
Practice address
100 MEDICAL DR, LAKE JACKSON, TX 77566-5674
(979) 299-1210
(979) 299-1137
Mailing address
129 CIRCLE WAY ST, SUITE A, LAKE JACKSON, TX 77566-5249
(979) 299-1210
(979) 299-1136
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0064NC
BLUE CROSS BLUE SHIELD
TX
05
—
1834285
—
TX
Enumeration date
08/21/2006
Last updated
08/07/2007
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